Glomerulonephritis

Question 1

what are 5 examples of glomerular disease

Answer 1

diabetic nephropathy, pyelonephritis (infection), glomerulonephritis (inflamm), amyloid nephropathy, transplant nephropathy

Question 2

what is glomerulonephritis

Answer 2

inflammation of the glomeruli usually by an autoimmune response

Question 3

what are types of glomerulonephtis (4)

Answer 3

nephritic syndrome (proteinuria), nephritic syndrome (haematuria), mixed, rapidly progressive

Question 4

what antibody mediated responses can cause glomerulonephritis (4)

Answer 4

intrinsic antigen, deposition of immune complexes, T cell mediated

Question 5

what can cause circulating immune complexes

Answer 5

infection eg hep C, HIV // drugs eg gold // cancer eg lymphoma

Question 6

what types of vasculitis can cause glomerulonephritis

Answer 6

GPA and MPA

Question 7

what secondary causes can cause glomerulonephritis

Answer 7

infection, drugs, malignancies, systemic eg ANCA vasculitis GPA and MPA, LUPUS

Question 8

what are symptoms of glomerulonephritis

Answer 8

haematuria (nephritic syndrome), proteinuria (nephrotic syndrome), HYPERTENSION, AKI, CDK, ESRD

Question 9

how do you diagnose glomerulonephritis

Answer 9

BP, bloods, urinalysis, kidney biopsy

Question 10

what investigations are done on the kidney biopsy

Answer 10

light microscopy, electro-microscopy, immunofluorescence

Question 11

what is seen in light microscopy

Answer 11

hypercellularity, inflamm cells, sclerosis and crescents (bad)

Question 12

what is seen in electron microscopy

Answer 12

basement membrane deposits

Question 13

what is seen in immunoflueroscence

Answer 13

antibody type

Question 14

what is proliferative glomerulonephritis

Answer 14

proliferation of mesengial cells

Question 15

what is focal vs diffuse disease

Answer 15

focal <50% of glomeruli affected and diffuse >50%

Question 16

what are crescents associated with

Answer 16

bad prognosis

Question 17

what are the treatment aims of glomerulonephritis

Answer 17

reduce proteinuria, induce remission, preserve long-term renal function

Question 18

what non-immunosuppresive treatment can be used in glomerulonephritis

Answer 18

anti-hypertensives, ACEi/ ARBs, diuretics, statins

Question 19

what immunosuppressive drugs are used to treat glomerulonephritis (6)

Answer 19

steroids eg prednisolone, azathioprine, cyclophosphate, caclineurin inhibitors, IV immunoglobulin, plasmapheresis

Question 20

what cells are the site of injury in nephrotic syndrome and what does this result in

Answer 20

podocytes: protein in urine and atrophies and loss of charge barriers

Question 21

is nephrotic syndrome proliferative or non-proliferative

Answer 21

non-proliferative

Question 22

what are the signs of nephrotic syndrome (5)

Answer 22

proteinuria >3g/day, hypoalbuminaemia, oedema, hypercholestraemia, normal renal function

Question 23

what is the main protein lost in nephrotic syndrome

Answer 23

albumin

Question 24

what are complications of nephrotic syndrome

Answer 24

infection, renal vein thrombosis, PE, volume depletion

Question 25

what are the 3 main categories of nephrotic syndrome

Answer 25

minimal change, focal segmental glomerulosclerosis, membranous

Question 26

what is the most common cause of nephrotic syndrome in children

Answer 26

minimal change

Question 27

what is the most common cause of nephrotic syndrome in adults

Answer 27

FSGS

Question 28

what is the 2nd most common cause of nephrotic syndrome in adults

Answer 28

membranous

Question 29

what types of nephrotic syndrome are likely to cause progressive renal failure

Answer 29

FSGS: 50% get ESRF in 10 years // membranous: 40% get ESRF with slow progression

Question 30

what type of renal biopsy do you do in minimal change nephrotic syndrome and what does it show

Answer 30

light microscopy - looks normal and is associated with good prognosis

Question 31

how do you treat minimal change nephrotic syndrome

Answer 31

oral steroids (94% remission) 2nd line cyclophosphamide

Question 32

what type of renal biopsy do you do in FSGS nephrotic syndrome and what does it show

Answer 32

immunoflueroscence: minimal Ig // light: rosneal appearance

Question 33

how do you treat FSGS

Answer 33

60% remission with steroids. 2nd line ciclosporin

Question 34

what does a renal biopsy show membranous nephrotic syndrome

Answer 34

sub-epithelial immune complex in basement

Question 35

how do you treat membranous nephrotic syndrome

Answer 35

steroids/ alkylating agents eg cyclophosphamide + all on ACEi's

Question 36

what cells are the site of injury in nephritic syndrome and what does this result in

Answer 36

mesangial cells: release chemokines --> inflamm /// endothelial --> vasculitis

Question 37

is nephritic syndrome proliferative or non-proliferative

Answer 37

proliferative - due to mesangial cell involvement

Question 38

how does nephritic syndrome present (6)

Answer 38

hypertension + haematuria, acute renal failure oliguria, oedema, henoch schonlein purpura (HSP)

Question 39

what is the most common cause of GN in the world

Answer 39

IgA nephropathy (nephritic)

Question 40

what are the symptoms if IgA nephropathy

Answer 40

asymptomatic haematuria, macroscopic haematuria after resp/ GI infection, HSP

Question 41

what is seen on a renal biopsy for IgA nephropathy

Answer 41

IgA deposits in mesangium and mesangial hypercellularity

Question 42

how commonly does IgA nephropathy progress to ESRF

Answer 42

25%

Question 43

how do you treat IgA nephropathy

Answer 43

BP control, ACE/ARBs, fish oil

Question 44

what is membranoproliferative GN

Answer 44

mixed nephrotic and nephritic syndrome

Question 45

what is seen in a biopsy of membranoproliferative GN

Answer 45

hypercellular glomeruli + thick membranes

Question 46

what is rapidly progressive GN

Answer 46

rapid deterioration of acute renal failure that is treatable

Question 47

what is rapidly progressive GN associated with

Answer 47

active urinary sediment, glomerular crescent on biopsy

Question 48

what are ANCA+ive causes of rapidly progressive GN

Answer 48

GPA, MPA

Question 49

what are ANCA-ive causes of rapidly progressive GN

Answer 49

goodpastures, HSP, SLE

Question 50

how do you treat rapidly progressive GN

Answer 50

steroids + cyclophsophamide/ azathioprine + supportive dialysis