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Gen Med (Renal) > Glomerulonephritis > Flashcards

Glomerulonephritis Flashcards

1
Q

Damage to the glomerulus in glomerulonephritis leads to restriction of blood flow. What does this lead to as a compensatory mechanism?

A

Hypertension

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2
Q

Damage to the glomerulus in glomerulonephritis leads to loss of the filtration mechanism. What clinical features may this lead to?

A

Proteinuria and haematuria

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3
Q

Damage to the glomerulus in glomerulonephritis leads to loss of the filtration capacity. What does this cause?

A

Reduced renal function

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4
Q

What happens to the blood pressure in the nephrotic and nephritic syndromes?

A

In nephrotic syndrome, BP is normal or mildly increased; in nephritic syndrome, BP is moderately or severely increased

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5
Q

What abnormality is most likely to be found in the urine in the nephrotic and nephritic syndromes?

A

In nephrotic syndrome, proteinuria is predominant; in nephritic syndrome, haematuria is predominant

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6
Q

What happens to the GFR in the nephrotic and nephritic syndromes?

A

In nephrotic syndrome, GFR is normal or mildly decreased; in nephritic syndrome, GFR is moderately or severely decreased

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7
Q

What are the 3 common primary causes of nephrotic syndrome?

A

Minimal change disease, focal segmental glomerulosclerosis (FSGS), membranous glomerulonephritis

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8
Q

What are 2 common secondary causes of nephrotic syndrome?

A

Diabetic nephropathy, amyloidosis

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9
Q

What are 2 common primary causes of nephritic syndrome?

A

IgA nephropathy, rapidly progressive glomerulonephritis

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10
Q

What are 2 common secondary causes of nephritic syndrome?

A

Vasculitis, anti-GBM disease

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11
Q

Which type of primary glomerulonephritis is most likely to present with a mixed nephrotic/nephritic syndrome?

A

Membranoproliferative glomerulonephritis

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12
Q

What are 2 common secondary causes of mixed nephrotic/nephritic syndrome?

A

SLE, post-streptococcal glomerulonephritis

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13
Q

Which investigation gives the most information about glomerulonephritis and is used to make an official diagnosis?

A

Renal biopsy

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14
Q

Why should a renal biopsy only be performed in patients with glomerulonephritis if it is going to alter the management plan?

A

There is a significant risk of bleeding

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15
Q

The presence of what two things on urine microscopy are most suggestive of bleeding and damage to the glomerulus?

A

Dysmorphic red cells and red cell casts

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16
Q

What two imaging tests should be performed in individuals with suspected glomerulonephritis?

A

Renal ultrasound and CXR

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17
Q

Levels of what in the blood can be used to monitor disease progression of glomerulonephritis?

A

C3

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18
Q

In most patients with glomerulonephritis, what is the target blood pressure?

A

< 130/80

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19
Q

In patients with glomerulonephritis who have proteinuria > 1g/day, what is the target blood pressure?

A

< 125/75

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20
Q

What drugs should always be given to patients with glomerulonephritis?

A

ACE inhibitor or ARB

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21
Q

The presentation of nephrotic syndrome is indicative of a non-proliferative process affecting which cells of the glomerulus?

A

Podocytes

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22
Q

What are the 3 features of nephrotic syndrome?

A

Proteinuria (> 3g/day), hypoalbuminaemia, oedema

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23
Q

What is often described as being the fourth feature of nephrotic syndrome?

A

Hyperlipidaemia

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24
Q

Other than hyperlipidaemia, what are the main complications of nephrotic syndrome?

A

Increased susceptibility to infection and thromboembolism

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25
Q

With nephrotic syndrome, there is a particular high risk of which thrombotic event?

A

Renal vein thrombosis

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26
Q

When should a renal biopsy be performed in children?

A

Only if there is no response to steroid treatment

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27
Q

How is oedema reduced in patients with nephrotic syndrome?

A

Loop diuretics and salt/fluid restriction

28
Q

How is proteinuria reduced in patients with nephrotic syndrome?

A

ACE inhibitor or ARB

29
Q

In patients with nephrotic range proteinuria, what other medications should be started to reduce the risk of complications?

A

A statin and an anticoagulant

30
Q

What is responsible for the damage to podocytes in minimal change disease?

A

T cells

31
Q

Selective proteinuria occurs in which type of primary glomerulonephritis?

A

Minimal change disease

32
Q

What is the commonest cause of nephrotic syndrome in children?

A

Minimal change disease

33
Q

Which type of primary glomerulonephritis has associations with NSAID use and Hodgkin’s lymphoma in adults?

A

Minimal change disease

34
Q

In minimal change disease, damage to the glomerulus is only detected on what histological assessment?

A

Electron microscopy

35
Q

What is seen on an electron microscopy of minimal change disease?

A

Effacement of the foot processes of podocytes

36
Q

What are the first and second line treatments for minimal change disease?

A

First line is prednisolone, second line is cyclophosphamide

37
Q

What is the risk of progression to ESRF in patients with minimal change disease?

A

1%

38
Q

Hyalinosis on histology is most suggestive of which type of glomerulonephritis?

A

Focal segmental glomerulosclerosis

39
Q

Which type of primary glomerulonephritis may occur secondary to sickle cell disease, heroin use, HIV or Alport’s syndrome?

A

Focal segmental glomerulosclerosis

40
Q

Which type of primary glomerulonephritis will show small areas of mesangial collapse and sclerosis on light microscopy, and podocyte foot process fusion on electron microscopy?

A

Focal segmental glomerulosclerosis

41
Q

Around 30% of cases of focal segmental glomerulosclerosis respond to treatment with what? If this doesn’t work, what should be used next?

A

30% of cases respond to treatment with steroids. If this doesn’t work, cyclophosphamide or ciclosporin can be used.

42
Q

Which type of primary glomerulonephritis has a high recurrence rate in transplanted kidneys?

A

Focal segmental glomerulosclerosis

43
Q

Which type of primary glomerulonephritis is due to anti-phospholipase A2 autoantibodies?

A

Membranous glomerulonephritis

44
Q

Which type of primary glomerulonephritis will show diffuse thickening of the basement membrane and a ‘spike and dome’ appearance with special silver staining on light microscopy?

A

Membranous glomerulonephritis

45
Q

Which type of primary glomerulonephritis will show electron dense sub-epithelial deposits on electron microscopy?

A

Membranous glomerulonephritis

46
Q

Which type of primary glomerulonephritis will show granular deposits of IgG and C3 along the basement membrane on immunofluorescence?

A

Membranous glomerulonephritis

47
Q

When is immunosuppression required in cases of membranous glomerulonephritis?

A

Only in particularly severe or progressive cases

48
Q

What are the potential outcomes of membranous glomerulonephritis?

A

1/3rd resolve spontaneously, 1/3rd respond to cytotoxic drugs, 1/3rd progress to CKD

49
Q

Which type of primary glomerulonephritis will show mesangial proliferation, thickened capillary walls and a ‘tram track’ basement membrane on light microscopy?

A

Membranoproliferative glomerulonephritis

50
Q

Nephritic syndrome is indicative of a proliferative process affecting which cells of the glomerulus?

A

Endothelial cells

51
Q

What is the most common nephropathy worldwide?

A

IgA nephropathy

52
Q

IgA nephropathy is an example of which type of hypersensitivity reaction?

A

Type III

53
Q

Does IgA nephropathy present with nephrotic or nephritic syndrome?

A

Nephritic syndrome

54
Q

When does IgA nephropathy typically occur?

A

During or shortly after a respiratory or GI infection

55
Q

What is the typical presentation of IgA nephropathy?

A

Episodic macroscopic haematuria in a young male

56
Q

Which type of primary glomerulonephritis shows diffuse mesangial IgA deposition and mesangial proliferation on light microscopy, and electron dense deposits in the mesangium on electron microscopy?

A

IgA nephropathy

57
Q

What does IgA nephropathy show on immunofluorescence?

A

IgA and C3 deposition in the mesangium

58
Q

IgA nephropathy has a similar histological appearance to which systemic condition?

A

Henoch-Schonlein purpura

59
Q

What percentage of adults with IgA nephropathy go on to develop end stage renal failure?

A

20%

60
Q

When does post-streptococcal glomerulonephritis typically occur?

A

1 - 12 weeks after a streptococcal throat or skin infection

61
Q

What serology test will be increased in post-streptococcal glomerulonephritis?

A

ASOT

62
Q

What treatment is required for post-streptococcal glomerulonephritis?

A

Supportive treatment only

63
Q

What biopsy finding is seen in all cases of rapidly progressive glomerulonephritis?

A

Crescents

64
Q

How does rapidly progressive glomerulonephritis tend to present?

A

AKI +/- systemic features

65
Q

How is rapidly progressive glomerulonephritis treated?

A

High dose IV steroids and cyclophosphamide +/- plasma exchange

Gen Med (Renal) (18 decks)

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