glomerulonephritis

Question 1

what are the features of nephritic syndrome?

Answer 1

haematuria
(sub-nephrotic levels) proteinuria
high blood pressure
Rising serum creatinine

Question 2

what causes nephritic syndrome?

Answer 2

IgA nephropathy
Post-infectious GN
vasculitis and anti-GBM disease

Question 3

what are the features of nephrotic syndrome?

Answer 3

The O’s

Proteinuria (>3.5g/d)
HypOalbuminaemia
Oedema
hyperlipidaemia

Question 4

what causes nephrotic syndrome?

Answer 4

deposition diseases 
minimal change disease 
focal and segmental glomeruloscerlosis 
membranous nephropathy 
membranoproliferative GN

Question 5

how does IgA nephropathy present?

Answer 5

Haematuria
hypertension
proteinuria (<1g/d)

can be precipitated by infection or secondary to HSP, cirrhosis or coeliacs

Question 6

How is IgA nephropathy diagnosed and treated?

Answer 6

renal biopsy - IgA and C3 deposition in mesagium and mesangial proliferation

treated with ACEi/ARB and corticosteroids

Question 7

how does Henoch Schonlein purpura present?

Answer 7

purpuric rash on extensor surfaces
polyarthritis
abdo pain and GI bleeding
Nephritic features

Question 8

what infection can precipiate glomerulonephritis?

Answer 8

streptococcal throat or skin infection

Question 9

Anti GBM disease is also known as Goodpastures disease. what causes it and how does it present?

Answer 9

autoantibodies to type V collagen in glomerular and alveolar BM’s

renal disease wiith oliguria, haematuria, AKI
Lung disease with SOB, haemoptysis

Question 10

how is anti GBM disease diagnosed and treated?

Answer 10

cresenteric disease on biopsy.
Anti GBM autoanttbodies in circulation

plasma exchange
corticosteriods
cyclophosphamide

Question 11

how does rapidly progressive GN present and how is it diagnosed and treated?

Answer 11

aggressive nephritis that progresses to renal failure in days to weeks

any GN may transform to this

cresents on biopsy

corticosteroids and cyclophosphamide

Question 12

what are the complications of nephrotic syndrome?

Answer 12

thromboembolism
infection
hyperlipidaemia

Question 13

what can cause minimal change disease?

Answer 13

NSAIDs and lithium

Hodgkins lymphoma

Question 14

how is minimal change disease diagnosed and treated?

Answer 14

electron microscopy of renal biopsy shows podocyte effacement. light microscopy is normal

Prednisolone

Question 15

what can cause focal segmental glomerulosclerosis and can it lead to?

Answer 15

HIV, heroin, lithium, lymphoma

at risk of progressive CKD and renal failure

Question 16

how is focal segmental glomerulosclerosis diagnosed and treated?

Answer 16

focal sclerosis of glomeruli on biopsy

ACEi/ARB
corticosteroids

Question 17

membranous is caused by which autoantibody in primary disease. What are secondary causes?

Answer 17

Antiphospholipase A2 receptor antibody

malignancy
infection (Hep B/C, strep, malaria)
Immunlogical disease (SLE, RA)

Question 18

how is nephrotic syndrome generally treated?

Answer 18

fluid and salt restriciton and loop diuretic for oedema

renal biopsy to determine cause

ACEi/ARB

Prednisolone

Question 19

a renal biopsy has been taken of a patient with nephrotic syndome. What features elude to the underlying cause?

Answer 19

diffusely thickened GBM with IgG deposits
- membranous nephropathy

normal
- minimal change disease

glomerulosclerosis
- focal segmental glomerulosclerosis

electron dense deposits and immunoglobulin deposition
- membranoproliferative

Question 20

a renal biopsy has been taken in a patient with nephritic syndrome. what features elude to the underlying cause?

Answer 20

IgA and C3 deposition in mesagium and mesangial proliferation

• IgA nephropathy
• HSP

Cresenteric disease

• Anti GBM
• rapidly progressive GN