Glomerulonephritis

Question 1

Define glomerulonephritis?

Answer 1

Conditions causing inflammation of or around the glomerulus.

Question 2

What is nephritic syndrome?

List 5 features

Answer 2

Heamaturia due to inflammatory damage.

1. Haematuria
2. Oliguria
3. Proteinuria (less than 3g/24hr)
4. Fluid retention.

Question 3

What is nephrotic syndrome?

List 4 features

Answer 3

Proteinuria due to podocyte damage.

1. Proteinuria >3g/24hr
2. Hypoalbuminaemia <30g/L
3. Peripheral oedema
4. Hyperlipidaemia.

Question 4

Initial Ix for glomerulonephritis: 
 Bloods (8)
 Urine (3)
 Imaging (2)
 Renal biopsy.

Answer 4

Bloods: FBC, U+E, LFT, CRP, immunoglobulins, electrophoresis, complement, autoantibodies (Anti-dsDNA, anti-GBM, ANA, ANCA).
Urine: MC+S, bence jones proteins, A: Cr.
Imaging; CXR, Renal USS

Question 5

List conditions causing nephritis syndrome (5)

Answer 5

1. IgA nephropathy
2. Henoch-Schonlein purpura.
3. Post-streptococcal glomerulonephritis.
4. Anti-GBM disease.
5. Rapidly progressive glomerulonephritis.

Question 6

What is IgA nephropathy (Berger disease)?
and pathophysiology (2 points)

Answer 6

Only affects KIDNEYS.
Kidney disease caused by IgA antibody deposition in the kidneys leading to local inflammation.

Galactose deficient IgA is not recognised by the body, thus it accumulates in the kidneys (instead of being degraded).
As it is not recognised as self, anti-glycan antibodies are made. These form immune complexes + are deposited in the mesangium causing inflammation

Question 7

Features of IgA nephropathy: 
  clinical symptoms (3)
  Ix (1)
  Tx (2)
  Prognosis

Answer 7

Clinical features: Asymptomatic. Heamaturia. HTN
Ix: Renal biopsy = IgA deposition in mesangium.
Tx: ACEi (reduced proteinuria). Steroids (Prevent immune complexes)
Prognosis: Slow indolent disease, progresses to renal failure over 30yrs (20-50%)

Question 8

what is Henoch Schonlein purpura?

Answer 8

Small vessel vasculitis = IgA directly attacks small blood vessels.
Systemic variant of IgA nephropathy with IgA deposition in skin, joints, gut, + kidney.

Question 9

List clinical features of HSP? (4)

Answer 9

Palpable purpuric rash on extensor surfaces
Flitting polyarthritis
Abdominal pain (gut bleeding)
Nephritic syndrome

Question 10

Diagnosis + Tx of HSP?

Answer 10

Ix: clinical, renal biopsy = IgA deposition in mesangium.
Tx: ACEi and steroids.

Question 11

What is post-streptococcal glomerulonephritis?

Answer 11

Occurs 3 wks after throat or skin infection.
Streptococcal antigen becomes deposited in the glomerulus + forms immune complexes causing inflammation (type 3 hypersensitivity reaction).

Question 12

Clinical features of post-step GN? (think nephritis features)

Answer 12

Heamaturia
oedema
oliguria
HTN

Question 13

Ix and Tx of post-strep GN?

Answer 13

Ix: High anti-DNAse. low C3.
Tx: supportive.

Question 14

What is anti-glomerular basement membrane disease:

Answer 14

Autoantibodies develop to type 4 collagen, which is found in the glomerular + alveolar basement membrane. These activate complement system.

Question 15

Anti-GBM disease:
Clinical features (4)
Ix (1)
Tx (2)

Answer 15

Clinical features; Heamaturia, AKI, Heamoptysis, sob.
Ix: anti-GBM antibodies
Tx: Plasma exchange. Steroids.

Question 16

what is rapidly progressive glomerulonephritis?

Answer 16

Any glomerulonephritis that progresses to renal failure over days to weeks

Question 17

Causes of rapidly progressive GN? (5)

Answer 17

Small vessel vasculitis 
Lupus nephritis 
Anti-GBM disease 
IgA nephropathy 
Membranous glomerulonephritis

Question 18

what is seen on renal biopsy of rapidly progressive GN?

Answer 18

Crescent shaped cell proliferation in bowman’s space.

Question 19

Primary causes of nephrotic syndrome? (4)

Answer 19

Minimal change disease.
Membranous neuropathy.
Focal segmental glomerulosclerosis. Membranoproliferative GN (MPGN).

Question 20

Secondary causes of nephrotic syndrome? (4)

Answer 20

Diabetes
Lupus nephritis
Myeloma
Pre-eclampsia

Question 21

Treatment of nephrotic syndrome? (3)

Answer 21

1. Reduce oedema = Fluid + salt restriction. Furosemide. Daily weight (0.5-1kg loss/day)
2. Treat cause = Renal biopsy. Steroids.
3. Reduce proteinuria = ACEi

Question 22

Complications of nephrotic syndrome? (4)

Answer 22

1. Thromboembolism - blood is hypercoagulable.
2. Infection
3. Hyperlipidaemia
4. HTN

Question 23

Minimal change disease:

Answer 23

Commonest cause in children.
Cause – idiopathic, drugs, paraneoplastic.
Ix: Normal, electron microscopy = effacement of podocyte foot processes.
Tx: Prednisolone.

Question 24

Focal segmental glomerulosclerosis:

Answer 24

Commonest cause in adults.
Cause: Idiopathic. Sickle cell, HIV, heroin.
Biopsy: scarring in some areas of glomerulus.
Tx: ACEi + BP control. 1st steroids. 2nd calcineurin inhibitors.

Question 25

Membranous nephropathy

Answer 25

Inflamed glomerular basement membrane.
Cause: Idiopathic. Malignancy, infection, autoimmune. Ix: anti-phospholipid A2 receptor antibody. Thickened GBM.
Tx: ACEi + BP control, steroid (some cases).

Question 26

Membranoproliferative glomerulonephritis

Answer 26

Immune deposits in sub-endothelial layer.
Light microscopy - Tram track appearance.
Tx: ACEi + BP control.