Glomerulonephritis

Question 1

What are the clinical features in nephritic syndrome?

Answer 1

Haematuria (visible or non-visible)
Oliguria (reduced output)
Proteinuria < 3g/24hr
Fluid retention

Question 2

What are the criteria for nephrotic syndrome?

Answer 2

All of:

• peripheral oedema
• proteinuria >3g/24hr
• serum albumin <25g/l
• hypercholesterolaemia

Question 3

What is the difference between glomerulonephritis and interstitial nephritis?

Answer 3

Glomerulonephritis - inflammation of/around the glomerulus

Interstitial nephritis - inflammation of the space between cells and tubules (interstitium)

Question 4

What is glomerulosclerosis and what causes it?

Answer 4

Scarring of the glomerulus caused by:

• any glomerulonephritis
• obstructive uropathy
• focal segmental glomerulosclerosis

Question 5

How are most types of glomerulonephritis treated?

Answer 5

Immunosuppression e.g. steroids

Blood pressure control with ACEi or ARBs

Question 6

What are the different types of glomerulonephritis?

Answer 6

Minimal change disease
Focal segmental glomerulosclerosis
Membranous GN
IgA nephropathy (mesangioproliferative GN or Berger's disease)
Post streptococcal GN (diffuse proliferative GN)
Mesangiocapilliary GN
Rapidly progressive GN
Goodpastures syndrome

Question 7

How do patients with nephrotic syndrome usually present?

Answer 7

Oedema 
Frothy urine (proteinuria)

Question 8

What is the most common cause of nephrotic syndrome in children?

Answer 8

Minimal change disease

Question 9

What is the most common cause of nephrotic syndrome in adults?

Answer 9

Focal segmental glomerulosclerosis

Question 10

What are the features of minimal change disease?

Answer 10

Nephrotic syndrome in children
Idiopathic
Responds well to steroids

Question 11

What is IgA nephropathy also called?

Answer 11

Berger’s disease

Question 12

What is the peak age for IgA nephropathy? What are the features?

Answer 12

20s

1-2 days post URTI

Question 13

What is seen on histology in IgA nephropathy?

Answer 13

IgA deposits + glomerular mesangial proliferation

Question 14

What is the most common type of glomerulonephritis? What age of patients typically get it?

Answer 14

Membranous GN

- peak in 20s and 60s

Question 15

What causes membranous GN?

Answer 15

Majority idiopathic
May be secondary to:
- malignancy
- rheumatoid disorders
- drugs e.g. NSAIDs

Question 16

What is seen on histology in membranous GN?

Answer 16

IgG and complement deposits on the basement membrane

Question 17

What are the features of post streptococcal GN?

Answer 17

Patients under 30:

• 1-3 weeks post strep infection (tonsillitis or impetigo)
• nephritic syndrome
• usually full recovery

Question 18

What are the features of goodpasture syndrome?

Answer 18

Anti-GBM antibodies attack glomerulus and pulmonary basement membranes
–> glomerulonephritis (AKI) + haemoptysis

Question 19

What are the features of rapidly progressive GN?

Answer 19

Very acute illness with sick patient but responds well to treatment

Question 20

What does histology show in rapidly progressive GN?

Answer 20

Crescentic glomerulonephritis