Glomerulonephritis

Question 1

What are the functions of the kidney?

Answer 1

Waste excretion
Water balance
Salt balance
Acid base control
Endocrine functions

Question 2

What are the components of the glomerular filtration barrier?

Answer 2

Endothelial cell
Glomerular basement membrane
Podocytes

Question 3

Describe the endothelial cells in the glomerular filtration barrier?

Answer 3

Fenestrated

Bulnerable to immune mediated attack

Question 4

What are the components of the glomerular basement membrane?

Answer 4

Type IV collagen
Laminin
Mesangial cells

Question 5

What are mesangial cells?

Answer 5

Glomerular structural support
Embedded in glomerular basement membrabe
Regulate blood flow of glomerular capillaries

Question 6

Describe podocites in the glomerular filtration barrier?

Answer 6

Proteins containing slit diaphragms

Question 7

What is glomerulopathy?

Answer 7

Proteinuria and haematuris in varying amounts

Question 8

What does increasing proteinuria suggest?

Answer 8

Nephrotic

Question 9

What does increasing haematuria suggest?

Answer 9

Nephritic

Question 10

What is the presentation of nephrotic syndrome?

Answer 10

Well, normally 2-5 year olds
Oedema- periorbital, pitting oedema of legs
Ascites, small pleural effusions
Frothy urine
Proteinuria
Intravascular depletion

Question 11

What are the types of causes of nephrotic syndrome?

Answer 11

Idiopathic
Acquired
Congenital

Question 12

What are the idiopathic causes of nephrotic syndrome?

Answer 12

Minimal change disease
Focal segmental glomerulosclerosis
Membranoproliferative glomerulonephritis

Question 13

What are the most common causes of acquired nephrotic syndrome?

Answer 13

IgA related vasculitis
Lupus
Post infective

Question 14

What does IgA vasculitic affect?

Answer 14

Mesangial cells

Question 15

What does lupus affect?

Answer 15

Endothelial cells

Question 16

What does post infective glomerulonephritis affect?

Answer 16

Basement membrane and endothelial cells

Question 17

What are congenital nephrotic syndromes?

Answer 17

rare, congenital

Affecting podocyte, endothelium and microvascular integrity and basement membrane proteins

Question 18

What investigations are done for nephrotic syndrome?

Answer 18

Dipstick
Protein creatinine ratio
24 hour urine collection
Bloods- albumin and ceratinine

Question 19

What would a nephrotic protein creatinine ratio be?

Answer 19

> 250 normal <20

Question 20

What is the treatment of nephrotic syndrome?

Answer 20

Prednisolone 8 weeks

Frequent long term relapses or steroid resistant- immunosuppression

Question 21

What are the common causes of nephritic syndrome?

Answer 21

Glomerulonephritis
UTI
Trauma
Stones

Question 22

What types of glomerulonephritis common cause nephritic syndrome?

Answer 22

Post infective
IgA related vasculitis
IgA neohropathy

Question 23

How can the causes of nephritic syndrome be differentiated?

Answer 23

UTI= associated dysuria
Sones= associated pain

Question 24

What is the presentation of nephritic syndrome?

Answer 24

Increasing haematuria
proteinuria
Intravascular overload- hypertension, raised JVP, oedema
Oliguria

Question 25

What investigations are done for nephritic syndrome?

Answer 25

Bloods- FBC, creatinine, albumin Urine dipstick and culture Renal US

Question 26

What is the most common cause of post infective glomerulonephritis?

Answer 26

Usually group A strep Throat infection in last 7-10 days Skin infection in last 2-4 weeks

Question 27

What is the differential for post infective glomerulonephritis?

Answer 27

IgA nephropathy membranoprolifeartive glomeruloneohropathy Lupus

Question 28

How is post infective glomerulonephritis diagnosed?

Answer 28

Bacterial culture | ASOT +

Question 29

What is the treatment of post infective glomerulonephritis?

Answer 29

Antibiotics Support renal function Diuretics if overload/hypertension

Question 30

What is IgA nephropathy?

Answer 30

Most common glomerulonephritis, normally occurring 1-2 days after a URTI Usually older children and adults

Question 31

What are the features of IgA nephropathy?

Answer 31

Recurrent macroscopic haematuria +/- chronic microscopic haematuria Varying degree of proteinuria

Question 32

What is the diagnosis of IgA neohropathy?

Answer 32

Negative autoimmune, normal compliment | rarely confirmation biopsy

Question 33

What is the treatment of IgA neohropathy?

Answer 33

Mild- ACE inhibitor | Mod to severe- immunosuppression

Question 34

What is IgA related vasculitis?

Answer 34

Dilatation of capillaries due to autoimmune IgA response | Age of onset 5-15

Question 35

What are the features of IgA vasculitis?

Answer 35

Palpable purpura plus 1 of - abdo pain - renal involvement - arthritis or arthralgia - IgA deposition on biopsy

Question 36

What are the common triggers for IgA vasculitis?

Answer 36

Viral URTI Strep Drugs

Question 37

What is the treatment of IgA vasculitis?

Answer 37

Symptomatic GI involvement- glucocorticoid Mod to severe renal= immunosuppression Long term hypertension and proteinuria screening

Question 38

What are the most common causes of nephritis syndrome?

Answer 38

Post infection GN IgA vasculitis IgA nephropathy

Question 39

What are the most common causes of nephrotic syndrome?

Answer 39

focal segmental GN | Minimal change disease