Glomerulonephritis and Nephrotic Syndrome

Question 1

Classification?

Answer 1

1. prerenal
2. intrarenal
3. postrenal

Question 2

Functional unit of the kidney?

Answer 2

nephron

Question 3

Causes of kidney injury?

Answer 3

1. Acute Glomerulonephritis (5%)
2. Acute Tubular Necrosis
   a. toxin (35%)
   b. ischemic (50%)
3. Acute Interstitial Nephritis (10%)

Question 4

Causes of acute glomerulonephritis?

Answer 4

causes can be primary or secondary
1. Anti-Glomerular Basement Membrane antibody diseases
2. Immune Complex GN
3. Pauci-immune GN

Question 5

Primary causes of glomerulonephritis?

Answer 5

1. Membranous proliferative GN
2. IgA nephropathy
3. Cresentic GN
4. Fibrillary GN

Question 6

Secondary causes of glomerulonephritis?

Answer 6

1. SLE
2. Post-streptococcal GN
3. Hep C
4. Medicine toxicities
5. Amyloidosis
6. Vascular e.g. Wegners Granulomatosus
7. Infective endocarditis

Question 7

When does post-streptococcal GN occur?

Answer 7

1. 6-10 days after throat infection
2. 10-14 days after skin infection

Question 8

Epidemiology of post-streptococcal GN?

Answer 8

Common in children 6-10 years old

Question 9

Diagnosing post-streptococcal GN microscopically?

Answer 9

1. Nephritogenic streptococci identified
2. Shows sub-epithelial humps on electron Microscopy

Question 9

Diagnosing acute GN?

Answer 9

1. Red Blood Cell casts
2. Rapidly increasingly creatinine
3. Renal biopsy findings

Question 9

What can be seen in urine microscopy when diagnosing GN?

Answer 9

Different types of casts
1. Epithelial
2. Red Cell
3. Leucocyte
4. Granular
5. Hyaline

Question 9

Characteristic features of nephrotic syndrome?

Answer 9

1. Massive proteinuria >3.5g/dy
2. Hypoalbuminemia
3. Hyperlipidemia
4. Edema
5. Frequently associated with underlying glomerular disease
6. It’s a non-inflammatory process

Question 10

Characteristic features of nephritic syndrome?

Answer 10

1. Hallmark - Hematuria/ Red Cell Casts
2. Low Grade proteinuria
3. Hypertension
4. Edema
5. Decreasing renal function
6. Can be primary kidney disease or from another systemic disease
7. Its an inflammatory process

Question 11

Causes of nephrotic syndrome?

Answer 11

1. minimal change disease
2. focal segmental glomerulosclerosis
3. membranous
4. diabetic nephropathy
5. amyloid
6. membrano-proliferative GN
7. HIV associated nephropathy

Question 12

Causes of hypocomplementemia in renal disease?

Answer 12

1. SLE
2. MPGN
3. Cryoglobulinemia (Hep C)

Question 13

Investigations for nephrotic syndrome?

Answer 13

1. FBC, ESR, LFT, RFT
2. ANA, ANCA,
3. Serum complement studies
4. Hepatitis studies
5. HIV serology
6. Serum cryoglobulins
7. Rheumatoid Factor
8. Serum Electrophoresis and Urine Protein electrophoresis
9. HbA1c

Question 14

When is it important to do a renal biopsy?

Answer 14

Important in nephrotic range proteinuria for
1. diagnosis of actual cause and prognosis
2. also important to assess possible recurrence of disease in transplanted kidney

Question 15

When is it not important to do a renal biopsy?

Answer 15

Not important in sub-nephrotic range proteinuria
- These cases are usually tubulointerstitial diseases and biopsy findings are not specific unlike in the glomerular diseases

Question 16

Complications of NS/GN?

Answer 16

1. Edema and ascites
2. Progression to ESRD
3. Low immunity – reduction in C3 and 4 through C4, immunoglobulin loss in urine
4. Hypercoagulability including Pulmonary embolism and Renal vein Thrombosis
5. Hyperlipidemia and accelerated atherosclerosis
6. Hypertension

Question 17

Treatment in GN and NS?

Answer 17

Supportive –
1. HTN + proteinuria - ACEi/ARBs
2. edema - loop diuretics: furosemide
3. lipids - statins
4. coagulation - prophylactic low molecular weight heparin

Question 18

Treatment in NS?

Answer 18

1. immunosupressants
   - Methylprednisolone
   - Cyclophosphamide
   - Mycophenolate Mofetil
   - Immuran
   - Cyclosporine
   Plasmapharesis
   - anti-GBM disease
   Thrombolysis
   - Asa, Warfarin