glomerulonephritis

Question 1

what is the hallmark of glomerulonephritis ?

Answer 1

excretion of protein in the urine

Question 2

what are the clinical presentation of glomerular disease ?

Answer 2

.asymptomatic 
.macroscopic heamturia 
.nephrotic syndrome 
.nephritic syndrome 
.rapidly progressive glomerulonephritis 
.chronic glomerulonephritis

Question 3

what is the pathophysiological classification of glomerular disease ?

Answer 3

1. immune mediated
2. protein deposition
3. Miscellaneous ( drug induced, inherited)

Question 4

when do we consider glomerular disease in aetiology ?

Answer 4

presenting with hypertension 
edema 
proteinuria 
hematuria 
AKI 
CKD

Question 5

what are the primary nephritic syndrome glomerular pathologies ?

Answer 5

• immunoglobulin A Nephropathy
• anti-glomerular basement membrane disease
• thin basement membrane nephropathy ( Alport Syndrome )

Question 6

what is nephritic syndrome ?

Answer 6

presence of hematuria, accompanied by RBC casts

oliguria

Question 7

what are the secondary nephritic syndrome glomerular pathologies ?

Answer 7

• Lupus nephritis
• membrenoproliferative GN
• post infectious GN

Question 8

what is the onset of nephritic syndrome in children with PIGN ? and what is the most common causative organism ?

Answer 8

onset is after infection

and is predominantly streptococcal

Question 9

what is the onset of nephritic syndrome in adults with PIGN and the most common causative organism ?

Answer 9

onset is during the ongoing infection and it is more likely to be staphylococcal

Question 10

where id the site of infection in children with PIGN ?

Answer 10

pharyngitis

skin as with impetigo

Question 11

what is the other name for Immunoglobulin A nephropathy?

Answer 11

Berger’s disease

Question 12

what is the most common cause of glomerulonephritis ?

Answer 12

IgA nephropathy

Question 13

what is the diagnostic measure taken for IgA nephropathy ?

Answer 13

immunofluorescence

Question 14

what do patients with IgA present with ?

Answer 14

usually macroscopic hematuria in v late stages the disease can shift to nephrotic

Question 15

How can IgAN happen ?

Answer 15

can occur with upper respiratory tract infections as a site of entry
may also be associated with alcoholic liver cirrohsis

Question 16

which causative organism can cause severe IgAN ?

Answer 16

s.aureus

Question 17

when can nephrotic proteinuria occur in IgAN ?

Answer 17

• early in the disease course if IgAN + minimal change disease
• late if it is 2ry too glomerular scarring

Question 18

what are the secondary causes of IgAN ?

Answer 18

rheumatic/autoimmune disease
GIT/liver disease
Infections

Question 19

what is the treatment approach for IgAN

Answer 19

give ARBs
immunosuppression
corticosteroids - predinsolone

Question 20

what are the criteria for diagnosing Lupus nephritis ?

Answer 20

mala rash 
discoid rashes 
photosensitivity 
oral ulcers 
arthritis
serositis 
kidney disorder
Anti-dsDNA 
ANA
neurological, haematological or immunological disorder

Question 21

what are the treatment options for lupus nephritis ?

Answer 21

IV steroids

RAAS blockade

Question 22

what are the most common causes of membrenoproliferative GN

Answer 22

hepatits C virus

Question 23

what is the old classification for MBP GN?

Answer 23

type I : IC deposits in the mesangium and sub endothelial space
type II : continuous, dense ribbon-like deposits in GBM
dense deposit disease
type III : sub endothelial and sub epithelial IC deposits

Question 24

what is the new classification of MPGN?

Answer 24

• positive for both IG and complement
• positive for complement
• no immunofluroscense (negative for both)

Question 25

what is another name for granulomatosis with polyangitis ?

Answer 25

wegner's granulomatosis

Question 26

what are the presenting symptoms of GPA ?

Answer 26

history of recurrent sinusitis hemoptysis heamturia severe AKI

Question 27

what are the lab findings in GPA ?

Answer 27

cANCA +ve | crescents found in renal biopsy

Question 28

what is the treatment for Wegner's granulomatosis ?

Answer 28

Steroids cyclosporine plasmapheresis may be required

Question 29

what is churg-strauss syndrome ?

Answer 29

a type of vasculitis

Question 30

what is the other name for churg-stauss syndrome ?

Answer 30

eosinophilic granulomatosis with polyangitis

Question 31

what is the clinical presentation of Churg-stauss syndrome | eosinophilic granulomatosis with polyangitis ?

Answer 31

-similar presentation to GPA/Wegner's disease -significant allergic/asthmatic features the triad consists of : hypereosinophilia asthma pulmonary infiltrates

Question 32

what is a crucial symptom for diagnosis of Churg-stauss syndrome ?

Answer 32

Asthma is a must for diagnosis

Question 33

what are the lab findings in Churg-strauss syndrome ?

Answer 33

pANCA positive | renal biopsy shows granuloma and eosinophils

Question 34

what is the treatment for Churg-strauss ?

Answer 34

steroids cyclosporine

Question 35

what is the pathogenesis of anti glomerular basement membrane disease ?

Answer 35

antibodies are found for type 4 collagen , and is limited to the lungs and kidney

Question 36

what other syndrome is associated with Anti-GBM GN ?

Answer 36

Good Pastures disease

Question 37

what is the clinical presentation of Anti-glomerular basement membrane disease

Answer 37

- alveolar haemorrhages and severe anuric AKI | - No skin or GIT involvement

Question 38

what are the lab investigations for anti-glomerular disease?

Answer 38

* Check Anti-GBM Abs’ levels. | * Bx: Immunofluroscense : +ve Anti-GBM Abs

Question 39

what is the treatment for anti-glomerular disease ?

Answer 39

pulse steroids +cyclosporine plasmapheresis relapses are rare

Question 40

what is polyarteritis noda PAN ?

Answer 40

- medium vessel vasculitis - multi system involvement except the lungs - more common in hepatitis B virus patients

Question 41

what is the common presentation of PAN ?

Answer 41

- hepatits B patient complaining of abdominal pain, fatigue and weight loss - postprandial abdominal pain - livedo reticularis

Question 42

what are the lab findings in PAN ?

Answer 42

anemia raised ESR raised CRP

Question 43

what is the treatment for PAN?

Answer 43

steroids | cyclosporine

Question 44

what are examples of thrombotic microangiopathies?

Answer 44

- thrombotic thrombocytopenia purpura (TTP) | - Hemolytic uremic syndrome (HUS)

Question 45

what is the characteristic triad of HUS ?

Answer 45

hemolytic anemia Uremia Thrombocytopenia

Question 46

what is the characteristic pentad of TTP?

Answer 46

``` hemolytic anemia thrombocytopenia uremia fever CNS changes ```

Question 47

what type of cells would we find in a peripheral blood smear of TTP/HUS ?

Answer 47

schistocytosis

Question 48

what are the biopsy findings in TTP/HUS?

Answer 48

small thrombi within glomerular capillary loops

Question 49

what is important to take into consideration when treating TTP/HUS ?

Answer 49

- DO NOT give PLATELET transfusion. | - DO NOT give Antibiotics.

Question 50

what are the types of cryoglobulinemia ?

Answer 50

type I: Multiple myeloma type II: HCV Type III: SLE , rheumatoid arth

Question 51

what is the common clinical presentation of cryoglobulinemia ?

Answer 51

HCV patient with joint pain and rash

Question 52

what would the lab finding of cryoglobulinemia be ?

Answer 52

serum cryoglobulins rheumatoid factor low complements

Question 53

what is Henoch-Schonlein Purpura

Answer 53

a type of vasculitis commonly found in children

Question 54

what are the findings in Henoch-Schonlein Purpura ?

Answer 54

purpura of the extremities arthritis colicky abdominal pain

Question 55

what is nephrotic syndrome ?

Answer 55

- protein excretion of more than 3.5mg - hypoalbuminemia - hypercholesterolemia - peripheral edema

Question 56

what is classified under secondary nephrotic syndrome?

Answer 56

diabetic nephropathy | renal amyloidosis

Question 57

what are the diagnostic workup for glomerular disease?

Answer 57

determine patients GFR urinalysis quantify proteinuria Renal US

Question 58

what are some additional lab investigations to consider ?

Answer 58

``` hepatitis panel HIV testing complement levels RF cryoglobulins ANA ANCA Anti-GBM ```

Question 59

what are the complications of nephrotic syndrome ?

Answer 59

1. Negative Nitrogen Balance 2. Hypercoaguability 3. Lipid Abnormalities 4. Infections 5. AKI 6. CKD 7. Peripheral edema 8. Hypercholesteremia 9. Anemia

Question 60

what is classified under primary nephrotic syndrome glomerular pathology ?

Answer 60

- Minimal change nephrotic syndrome - membranous nephropathy - focal segmental glomerulosclerosis

Question 61

what is the main cause of nephrotic syndrome?

Answer 61

minimal change disease

Question 62

response of MCD to therapy ?

Answer 62

almost always steroid sensitive

Question 63

what does the renal biopsy show in kids with steroid resistant NS?

Answer 63

focal segmental glomerulosclerosis

Question 64

what are the causes of focal segmental glomerulosclerosis?

Answer 64

-familial/genetic -virus associated ( HIV patient , parvovirus ) -drug induced

Question 65

what is the most common cause of nephrotic syndrome in noon DM adults ?

Answer 65

Membranous glomerulopathy

Question 66

what is alport's syndrome?

Answer 66

a rare x-linked dominant disease with a type 4 collagen abnormality

Question 67

what is the typical presentation ?

Answer 67

a young patient who is deaf or has some form of ocular defects

Question 68

what is the prognosis of alports syndrome ?

Answer 68

no cure , ultimate progression to end stage renal disease