Glomerulonephritis and systemic diseases

Question 1

What are the 3 cardinal features of glomerular abnormalities?

Answer 1

1) Proteinuria
2) Haematuria
3) Urinary casts

Question 2

What is membranous GN?

Answer 2

A thickened glomerular basement membrane as a result of subepithelial immune complex deposits of IgG and C3. Usually idiopathic but can be secondary to malignancy.

Question 3

What is minimal change GN?

Answer 3

Podocyte foot processes fuse (seen on electron microscopy- immunological studies and light microscopy are normal)

Question 4

What is the most common cause of incidental haematuria?

Answer 4

IgA nephropathy

Question 5

What treatments are appropriate in all glomerulonephritis?

Answer 5

Aggressive blood pressure treatment
Statins
Avoid nephrotoxic drugs

Question 6

What is the main treatment for minimal change GN?

Answer 6

Corticosteroids

Question 7

How can we treat membranous GN with deteriorating renal function?

Answer 7

Regimens including steroids and cyclophosphamide, ciclosporin or rituximab.

Question 8

How do we treat rapidly progressive GN?

Answer 8

More aggressive immunosuppressive regimens- including corticosteroids, cyclophosphamide and plasmapheresis.

Question 9

How do we slow progression of renal disease in diabetes?

Answer 9

Aggressive blood pressure control:
ACE inhibitors and/or ARBs.

Good glycaemic control
Smoking cessation
Control of lipids
Antiplatelet agents (aspirin)

Question 10

What are the pathologies causing renovascular disease?

Answer 10

1) Atherosclerotic renal artery stenosis.
2) Fibromuscular dysplasia.

Also: thromboembolism, renal artery dissection, cholesterol embolism

Question 11

How does atherosclerotic renal artery stenosis present?

Answer 11

HTN
Renal impairment
If bilateral, pulmonary oedema

Question 12

What are the 3 characterising features of HUS?

Answer 12

Haemolytic anaemia
Thrombocytopenia (platelet consumption)
acute renal failure

Question 13

In which vasculitis do we find pANCA?

Answer 13

Microscopic polyangiitis

Question 14

In which vasculitis do we usually find cANCA (in 90% of cases)?

Answer 14

Wegener’s granulomatosis (Granulomatosis with polyangiitis)

Question 15

What does a renal biopsy show in Wegeners?

Answer 15

Focal necrotizing GN, sometimes with crescent formation and granuloma.

Question 16

How do we treat Wegeners and microscopic polyangiitis?

Answer 16

Corticosteroids, cyclophosphamide (or rituximab) and plasmapheresis.

Question 17

What is Goodpasture’s syndrome characterised by?

Answer 17

Pulmonary haemorrhage (more common in smokers), haematuria, rapidly progressive renal failure.

Anti-GBM positive.

Question 18

Which systemic diseases can have renal involvement?

Answer 18

Diabetes mellitus
Myeloma
Amyloidosis
HUS
Renovascular disease
Renal vasculitis
Wegener's granulomatosis (granulomatosis with polyangiitis)
Microscopic polyangiitis
Goodpasture's syndrome
Polyarteritis nodosa (PAN)
SLE
Henoch-Schonlein purpura
Scleroderma
Cryoglobulinaemia