Glomerulonephritis

Question 1

features of nephritic syndrome?

Answer 1

haematuria (can be microscopic or macroscopic)
oliguria
proteinuria (not as much as nephrotic so must be <3g)
fluid retention (can be central/peripheral/anywhere)

Question 2

features of nephrotic syndrome?

Answer 2

peripheral oedema
proteinuria (3g or more in 24 hrs)
serum albumin <25g/L
hypercholesterolaemia

Question 3

how are most types of glomerulonephritis treated?

Answer 3

immunosuppression (eg steroids)
BP control (ACE inhibitors or ARBs)

Question 4

what does nephrotic syndrome predispose to?

Answer 4

thrombosis
hypertension
high cholesterol

Question 5

most common cause of nephrotic syndrome in children?

Answer 5

minimal change disease

Question 6

what usually causes minimal change disease?

Answer 6

idiopathic

Question 7

how is minimal change disease usually treated?

Answer 7

steroids

Question 8

most common cause of nephrotic syndrome in adults?

Answer 8

focal segmental glomerulosclerosis

Question 9

what is IgA nephropathy also known as?

Answer 9

bergers disease

Question 10

most common cause of primary glomerulonephritis (not caused by another disease)?

Answer 10

IgA nephropathy

Question 11

peak age of presentation of IgA nephropathy?

Answer 11

20s

Question 12

what does histology show in IgA nephropathy?

Answer 12

IgA deposits

glomerular mesangial proliferation

Question 13

most common glomerulonephritis overall?

Answer 13

membranous glomerulonephritis

Question 14

peak incidence of membranous?

Answer 14

bimodal peak

in 20s and 60s

Question 15

what does histology show in membranous?

Answer 15

IgG and complement deposits on basement membrane

Question 16

what causes membranous?

Answer 16

70% are idiopathic

can be secondary to malignancy, rheumatic disorders and drugs (eg NSAIDs)

Question 17

how does post-strep glomerulonephritis present?

Answer 17

patients usually under 30
1-3 weeks after strep infection (tonsillitis or impetigo)
develop nephritic syndrome
usually a full recovery

Question 18

what happens in goodpastures syndrome?

Answer 18

anti GBM antibodies attach glomerulus and pulmonary basement membranes
this causes glomerulonephritis and pulmonary haemorrhage

Question 19

classic picture of goodpastures disease?

Answer 19

acute kidney failure and haemoptysis

Question 20

what will histology show in rapidly progressive glomerulonephritis?

Answer 20

crescentic glomerulonephritis

Question 21

how does rapidly progressive glomerulonephritis usually present?

Answer 21

very acute illness with sick patients

often secondary to goodpastures

Question 22

what is glomerulonephritis?

Answer 22

group of kidney diseases mainly characterised by inflammatory disease primarily affecting the glomeruli
can be primary or secondary to other systemic disorder such as diabetes

Question 23

how can glomerulonephritis present?

Answer 23

nephrotic or nephritic

Question 24

types of primary glomerulonephritis?

Answer 24

membranous nephropathy
minimal change disease
focal segmental glomerulosclerosis
mesenagiocapillary (membranoproliferative)
IgA nephropathy
rapidly progressive glomerulonephritis

Question 25

which types of primary glomerulonephritis present with nephrotic syndrome?

Answer 25

membranous nephropathy minimal change disease focal segmental glomerulosclerosis mesenagiocapillary (membranoproliferative)

Question 26

which types of primary glomerulonephritis present with nephritic syndrome?

Answer 26

IgA nephropathy | rapidly progressive glomerulonephritis

Question 27

types of rapidly progressive glomerulonephritis?

Answer 27

type 1 = anti-GBM disease type 2 = immune complex (SLE, HSP, IgA) type 3 = vasculitis

Question 28

main cause of glomerulonephritis in kids?

Answer 28

minimal change disease

Question 29

main cause of glomerulonephritis in adults in overall?

Answer 29

IgA nephropathy

Question 30

how do most glomerulonephritis develop?

Answer 30

result of immune dysregulation which can be due to inappropriate response to self antigen or foreign antigen

Question 31

diagnostic features of minimal change disease?

Answer 31

electron microscopy might show effacement of podocytes but light microscopy and immunofluorescence dont show any changes

Question 32

second most common cause of glomerulonephritis in adults?

Answer 32

membranous

Question 33

which type of glomerulonephritis can present nephrotic or nephritic?

Answer 33

mesangiocapillary (membranoproliferative)

Question 34

what cause mesangiocapillary (membranoproliferative) glomerulonephritis?

Answer 34

immune deposition in the glomerulus, thickening of basement membrane and activation of complement pathway leads to glomerular damage

Question 35

which type of glomerulonephritis is most associated with hep C?

Answer 35

mesangiocapillary (membranoproliferative)

Question 36

diagnostic features of IgA nephropathy?

Answer 36

IgA deposition seen in glomerulus | presents with haematuria 1-2 days after symptoms of a URTI

Question 37

how is glomerulonephritis diagnosed?

Answer 37

``` urinalysis routine bloods for renal function, clotting, LFTs, glucose and inflammatory markers immuno-serological screen imaging renal biopsy ```

Question 38

how is urinalysis used in glomerulonephritis?

Answer 38

dipstick for urine anf blood culture and cytology microscopy can show dysmorphic red blood cells (low MCV) and casts

Question 39

types of serology screening in glomerulonephritis?

Answer 39

``` ANCA anti-GBM ANA anti-dsDNA C3 and C4 HBV, HCV and HIV serum immunoglobulins and urine electrophoresis (exclude myeloma) ```

Question 40

how is glomerulonephritis managed non pharmacologically?

Answer 40

lifestyle changes can help cases secondary to chronic disease (eg diabetes) salt and water restriction

Question 41

how can glomerulonephritis be managed pharmacologically?

Answer 41

ACEi can decrease proteinuria and improve mortality steroids reduce immunological factors and induce remission diuretics help with oedema and BP control statins help lipids anticoagulation in nephrotic syndrome as it causes hypercoagulability cyclophosphamide can be used in resistant cases (immune related)

Question 42

surgical management of glomerulonephritis?

Answer 42

renal transplant

Question 43

types of secondary glomerulonephritis that present nephrotic?

Answer 43

diabetes SLE class 5-6 amylooid hepatitis B/C

Question 44

what types of secondary glomerulonephritis present nephritic?

Answer 44

post-strep SLE class 1-4 vasculitis (HSP, GPA) goodpastures disease (anti-GBM)