Glomerulonephritis

Question 1

What proteins will not be filtered?

Answer 1

All proteins = to or larger than albumin

Question 2

What layers are contained within the filter barrier?

Answer 2

Endothelial cytoplasm
Basal lamina
Podocyte

Question 3

What layers make up the glomerular membrane?

Answer 3

Endothelium
Basal lamina
Podocyte foot process

Question 4

What are mesangial cells?

Answer 4

‘tree-like’ cell groups which support capillaries

Question 5

What is glomerulonephritis?

Answer 5

Disease of glomerulus

Inflammatory or non-inflammatory

Question 6

What is primary glomerulonephritis?

Answer 6

Disease only affecting the glomerulus

Question 7

What is secondary glomerulonephritis?

Answer 7

Affects other parts of the body

Question 8

What are the common presentations of glomerulonephritis?

Answer 8

Haematuria
Heavy proteinuria (nephrotic syndrome)
Slowly increasing proteinuria
Acute renal failure

Question 9

What is nephrotic syndrome?

Answer 9

So much albumin lost into the urine that oncotic pressure is lost –> oedema

Question 10

What are the main causes for haematuria?

Answer 10

UTI
Urinary tract stone
Urinary tract tumour
Glomerulonephritis

Question 11

What should always be checked before taking a renal biopsy?

Answer 11

Check clotting function

Question 12

How does IgA glomerulonephritis present histologically?

Answer 12

Accumulation of mesangial matrix with excess cells

IgA and complement component C3 in mesangial area

Question 13

What is the effect of increased presence of IgA on the glomerulus in IgA glomerulonephritis?

Answer 13

IgA deposits cause increased mesangial cell proliferation

Question 14

What gets clogged with IgA in glomerulonephritis?

Answer 14

Mesangium

NOT the filter membrane

Question 15

What is the prognosis of IgA nephropathy?

Answer 15

Mostly self-limiting

Some –> Renal failure

Question 16

What changes in the urine present in IgA nephropathy?

Answer 16

Blood in urine - sometimes microscopic

Question 17

How does Membranous glomerulonephritis present?

Answer 17

Spikes of new basement membrane matrix underneath podocytes
Thickened membrane
IgG deposits with spikes surrounding

Question 18

What immunoglobulin is seen in Membranous glomerulonephritis?

Answer 18

IgG stuck between basal lamina and podocyte

Question 19

What is the pathological effect of IgG being present in the membrane?

Answer 19

IgG is too big to be filtered

IgG activated C3 complement which punches holes in filter

Question 20

What is the role of complement?

Answer 20

Punches holes in the bacterial walls

Question 21

IgG is seen in the glomerular basement membrane in which condition?

Answer 21

Membranous Glomerularnephritis

Question 22

Leaking albumin through the filter causes what?

Answer 22

Nephrotic syndrome

Question 23

What is the prognosis of Membranous Glomerulonephritis?

Answer 23

1/4 in chronic renal failure within 10 years

Question 24

What is the most common antigen seen in membranous glomerulonephritis?

Answer 24

Phospholipase A2 receptor

Question 25

Patients with membranous glomerulonephritis sometimes have what?

Answer 25

Malignancy

Question 26

What are the renal implications of diabetic retinopathy?

Answer 26

Retinopathy = microvascular disease | ?glomerular disease

Question 27

How does the glomerulus appear in diabetic nephropathy?

Answer 27

Matrix deposition in the basal lamina and mesangial matrix Thick but leaky basement membrane Mesangium compresses capillaries

Question 28

Why do adhesions to the Bowmans capsule appear in diabetic nephropathy?

Answer 28

Glomerulus' attempt to stop massive leakage of albumin

Question 29

What are Kimmelsteil-Wilson lesions?

Answer 29

Gross excess of mesangial matrix forming nodules

Question 30

Kimmelsteil-Wilson lesions are seen in what?

Answer 30

In the glomerulus in diabetic nephropathy

Question 31

What is the prognosis of diabetic nephropathy?

Answer 31

Decline if established nephropathy and continued poor control

Question 32

Rapidly rising creatinine is suggestive of what?

Answer 32

Acute renal failure

Question 33

Cellular proliferation within Bowman's space is seen in what?

Answer 33

Crescentic glomerulonephritis

Question 34

Crescentic glomerulonephritis is caused by what?

Answer 34

Granulomatosis with polyangitis Microscopic polyarteritis Antiglomerular basement membrane disease

Question 35

How does Crescentic glomerulonephritis present histologically?

Answer 35

Crescent bowmans space full of proliferated cells | Bowmans space crushing the capillaries

Question 36

Granulomatosis with polyangiitis affects what?

Answer 36

Vessels in Kidneys, Lungs and nose

Question 37

How do you test for Granulomatosis with polyangiitis?

Answer 37

ANCA serum test | anti-neutrophil cytoplasmic antibodies

Question 38

What do anti-neutrophil cytoplasmic antibodies do?

Answer 38

Antibodies against proteinase 3 and myeloperoxidase (2 enzymes in primary granules of neutrophils) Tissue damage via interactions with primed neutrophils and endothelial cells

Question 39

What is the prognosis of Granulomatosis with polyangiitis?

Answer 39

Fatal (6m) if untreated Cyclophosphamide - 75% complete remission