Glomerulonephritis And Nephrotic Syndromes

Question 1

What is glomerulonephritis?

Answer 1

Inflammation of the glomeruli in the kidneys

Question 2

What is the overall general treatment principles for glomerulonephritis?

Answer 2

Treat targeted at underlying cause
Supportive care and immunosuppression like corticosteroids

Question 3

What is nephritic syndrome?

Answer 3

A group of features that occurs with nephritis (inflammation of the kidney)

Question 4

What are the features of nephritic syndrome?

Answer 4

Haematuria
Oliguria (significantly reduced urine. Output)
Proteinuria
Fluid retention

HTN

Question 5

What is nephrotic syndrome?

Answer 5

When the basement membrane of the glomerulus becomes highly permeable causing significant proteinuria

Question 6

What are the features of nephrotic syndromes?

Answer 6

Significant proteinuria
Low serum albumin (lost in urine)
Peripheral odema (loss of oncotic pressure due to hypoalbuminaemia)
Hypercholesterolaemia (due to inc albumin production)

Question 7

What effect does significant protienuria in nephrotic syndrome have on the urine?

Answer 7

Makes it frothy

Question 8

What are some complications of nephrotic syndrome?

Answer 8

Thrombosis
HTN
High cholesterol
Immunosuppression

Question 9

What is the most common nephrotic syndrome in kids (2-5)?

How would it present?

Answer 9

Minimal change disease

Odema
Proteinuria
Low albumin

Question 10

How would you treat minimal change disease?

Answer 10

Corticosteroids

Question 11

What are some nephrotic syndromes for adults?

Answer 11

Diabetic nephropathy
Focal Segmental Glomerulosclerosis
Membranous glomerulonephritis
Infection
Lupus nephritis
Amyloidosis
Medication inflicted

Question 12

What is the pathophysiology of minimal change disease?

Answer 12

Foot processes damaged
So gaps in basement membrane large allowing protien leakage

Question 13

How to remember main difference in presentation for Nephritic and Nephrotic syndromes?

Answer 13

NephItic = Inflammation of glomerular basement membrane causing Haematuria

NephrOtic = POdOcyte damage of basement membrane. Causing Odema (charge of podocytes not repelling albumin)

Question 14

What are some types of glomerulonephritis?

Answer 14

IgA nephropathy (bergers disease)
Goodpastures syndrome (anti-GBM glomerular basement membrane)
Rapidly progressing glomerulonephritis
Post streptococcal glomerulonephritis
Lupus nephritis

Question 15

What is IgA nephropathy?

How does it typically present?

Answer 15

IgA immune deposits in mesangial cells and mesangial proliferation. Usually a couple days (1-3days) post Upper Respiratory tract infection

20yr old
Haematuria
Most common cause of primary glomerulonephritis

Question 16

What is Goodpasture syndrome?

Answer 16

Anti-GBM antibodies attack glomerulus (Type IV collagen in basement membrane) and pulmonary basement membrane leading to glomerulonephritis. And pulmonary haemorrhage

Question 17

What is a typical presentation of Goodpasture syndrome?

Answer 17

20-60y/o patient
Acute Kidney Failure and Haemoptysis

Question 18

What is rapidly progressive glomuerlonephritis?
How does it look on histology?

Answer 18

Severe glomerular injury

Crescent shaped masses on histology

Question 19

What is post streptococcal glomerulonephritis?
What is recovery like?

Answer 19

1-3 weeks after infection by group A Beta haemolytic streptococcal infection of pharynx,tonsils or skin

Kidneys normally fully recover after Abx given to treat remaining infection

Question 20

What are some systemic disease that can cause glomerulonephritis?

Answer 20

HSP (Henoch-Schonlein purpura)
Vasculitis
Lupus nephritis

Question 21

What antibodies can you test for to determine cause of kidney injury?

Answer 21

Anti-GBM. Antibodies = Goodpasture syndrome
P-ANCA = microscopic polyangiitis (Vasculitis)
C-ANCA = granulomatosis with polyangiits (vasculitis)
ANA = Lupus screen
IgA = IgA nephropathy
Anti-streptolysin = post streptococcal glomerulonephritis

Question 22

How do you diagnose the cause of a nephrotic or nephritic syndrome?

Answer 22

Renal biopsy for Histology

Question 23

How do you manage nephrotic or nephritic syndromes?

Answer 23

Supportive care:
-HTN management (ACEi)
-Diuretics if oedematous
-DIALYSIS in severe cases

Immunosupression:
-corticosteroids

Question 24

What kidney disease is linked to IBD?

Answer 24

IgA nephropathy (glomerulonephritis)

Question 25

How would you investigate a patient presenting with blood in their urine 3 days after a URTI?

Answer 25

FBC U+Es (creatinine, eGFR, albumin/creatine ratio) Urine dip Serological tests (IgA)

Question 26

How does membranous glomuerlonephritis present?

Answer 26

Oedema Proteinuria Hypoalbuminaemia

Question 27

What investigations would you do. For a patient presenting with. Odema, and frothy urine?

Answer 27

U+Es Urine dip Serum albumin Albumin/creatinine ratio Lipid profile Renal USS Renal biopsy

Question 28

How do you manage a patient with membranous glomerulonephritis?

Answer 28

BP control (ACEi) Lipid control (anti-hyperlipidaemia drugs) Diuretics for oedma (furosemide) Anticoagulation (reduce VTE risk)

Question 29

What is Henoch Schonlein purpura?

Answer 29

Type of IgA vasculitis common in children

Question 30

How does Heneooch Schonlein purpura present?

Answer 30

Palpable purpura of the skin May or may not have renal disease

Question 31

What happens in post streptococcal glomerulonephritis?

Answer 31

Infection in the kidneys leads to oedematous glomeruli and neutrophil infiltration 1-3weeks after the URTI

Question 32

What investigations are done when ?post streptococcal glomerulonephritis?

Answer 32

BP Urine. Dip U+E Serology = Anti streptolysin Renal biopsy

Question 33

How may a lupus nephritis present?

Answer 33

B - symptoms/constitutional symptoms: -fatigue -fever -weight loss -night sweats -chills -lethargy Haematuria Proteinuria

Question 34

What Investigations would you want to do if you are suspecting a potential lupus nephritis?

Answer 34

Urine dipstick FBC U+Es LFT MCS of urine Albumin/creatinine ratio Glucose Serum albumin Serology: -ANA screen -Anti dsDNA -anti-sm Biopsy

Question 35

What is the most common finding on biopsy of a kidney with lupus nephritis?

Answer 35

Antigen-antibody complexes

Question 36

What is the gold standard investigation pathway if a patient presents with oedema?

Answer 36

Urine dip If abnormal with blood or protien do ALBUMIN TO CREATININE RATIO

Question 37

What investigations would you do for a patient preventing with oedema and frothy urine?

Answer 37

Glucose U+Es Urine dip Albumin to creatinine ratio (STANDARD SCREENING TOOL) Serum albumin Lipid profile

Question 38

Why if a patient has oedema and frothy urine is it important to check the blood glucose?

Answer 38

Most common cause for nephrotic syndromes is DIABETIC NEPHROPATHY

Question 39

How does diabetic nephropathy appear on biopsy?

Answer 39

Kimmelsteil Wilson nodules

Question 40

What serological test would you do for membranous glomerulonephritis?

Answer 40

PLAR2 gene

Question 41

What medications are most commonly associated with causing Nephrotic syndromes?

Answer 41

NSAIDs

Question 42

What screen would you give if you think Amyloidosis might be the cause of the nephrotic syndrome?

Answer 42

Myeloma screen

Question 43

What would a kidney look like on biopsy that had Amyloidosis causing the nephrotic syndrome?

Answer 43

Fibrils

Question 44

If a patient has high proteinuria but no oedema is this still nephrotic syndrome? If not what is it called?

Answer 44

No its not Nephrotic range proteinuria

Question 45

What is a good rule to follow in terms of proteinuria?

Answer 45

If the patient doesn’t have proteinuria, it’s not a renal issue

Question 46

Why is immunosuppression a potential complication of nephrotic syndrome?

Answer 46

Immunoglobulins are a type of protein that can also be lost in the urine

Question 47

Why is thrombosis/clot formation like DVTs a complication of nephrotic syndromes?

Answer 47

Fibrinolytic proteins are lost more than pro-thrombotic proteins

Question 48

What is considered a normal range for JVP?

Answer 48

-1 to 3 cm of H20

Question 49

How does IgA nephropathy appear on biopsy?

Answer 49

IgA immune deposits in mesangial cells Proliferation of mesangial cells Crescent moon shapes

Question 50

How does post-streptococcal glomerulonephritis appear on biopsy?

Answer 50

Neutrophil infiltration Antibody + Antigen complex Oedematous glomeruli

Question 51

How is lupus nephritis managed?

Answer 51

Immunosupression Corticosteroids DMARDs

Question 52

What is pauci-immune Glomerulonephritis?

Answer 52

Systemic autoimmune condition that’s a type of vasculitis causing haematuria

Question 53

What are some symptoms for pauci-immune glomerulonephritis?

Answer 53

B-symptoms: -fever -night sweats -weight loss -chills Epistaxis Nasal disease Sinus disease Cough Sputum SOB Wheeze HTN Haematuria Proteinuria

Question 54

What would be seen on microscopy of the urine with pauci-immune. Glomerulonephritis?

Answer 54

Dysmmmorphic RBC casts

Question 55

What serology would be positive with pauci-immune glomerulonephritis?

Answer 55

ANA ANCA

Question 56

How does a pauci-immune glomerulonephritis biopsy appear? How is this different to lupus nephritis?

Answer 56

Inflammation Fibrinoid crescents Doesn’t have lots of immune deposits like lupus

Question 57

How is pauci-immune glomerulonephritis managed?

Answer 57

Immunosupression: -Corticosteroids -DMARDs like methotrexate

Question 58

What affect can lithium, an antipsychotic drug have on the kidneys?

Answer 58

Drug induced diabetes Insipidus Acute interstitial nephritis