Glomerulonephritis Disease

Question 1

define IgA neuropathy

Answer 1

a type of glomerulonephritis characterised by IgA deposits within the glomeruli mesangium

Question 2

cause of IgA neuropathy

Answer 2

increased synthesis of IgA that forms immune complexes easily trapped within the mesangium, causing build up and responses that trigger damage

Question 3

clinical features of IgA neuropathy

Answer 3

gross or microscopic haematuria
hypertension
facial + leg oedema
recent respiratory illness

Question 4

investigations of IgA neuropathy

Answer 4

bloods (FBC, U+Es, RFTs, creatinine)
urinalysis + MC&S
renal biopsy with immunofluorescence staining

Question 5

common findings on investigations in IgA neuropathy

Answer 5

urine: +ve RBC + protein + WBCs
biopsy: IgA +C3 deposits in granular pattern in basement membrane

Question 6

conservative management of IgA neuropathy

Answer 6

monitor and optimise fluid balance

Question 7

medical management of IgA neuropathy

Answer 7

ACE inhibitors and ARBs

Question 8

indications for use of corticosteroids (e.g. prednisolone) in IgA neuropathy

Answer 8

severe inflammatory damage

rapidly declining kidney function

Question 9

define post-streptococcal glomerulonephritis (post strep GN)

Answer 9

a type of glomerulonephritis commonly occurring 1-2wks following a strep throat infection

Question 10

clinical features of post-strep GN

Answer 10

acute insidious onset of haematuria, oliguria, hypertension and periorbital oedema
previous streptococcal illness 1-6wks ago

Question 11

investigations of post-strep GN

Answer 11

urinalysis MC&S
bloods (FBC, U+Es, and immunoglobulins)
renal biopsy

Question 12

common findings on investigations of post-strep GN

Answer 12

biopsy: IgG and C3 subepithelial deposition
urine: +ve blood + protein

Question 13

management of post-strep GN

Answer 13

supportive measures

Question 14

define anti-glomerular basement membrane disease (Goodpastures)

Answer 14

a genetic autoimmune condition characterised by a combo of glomerulonephritis, alveolar haemorrhage and circulating anti-GBM antibodies

Question 15

risk factors of goodpastures disease

Answer 15

genetics (HLA-DRB1)
smoking 
exposure to organic solvents/hydrocarbons 
infection 
cocaine inhalation 
occupational exposure to metal dusts

Question 16

clinical features of goodpastures disease

Answer 16

fluctuating fever 
nausea + vomiting 
weight loss 
chest pain + SOB 
oedema 
haematuria 
arthralgia

Question 17

investigations of Goodpastures disease

Answer 17

bloods (FBC, U+Es, ESR, antinuclear antibodies and complement)
CXR
renal or lung biopsy

Question 18

management of Goodpastures disease

Answer 18

plasmapheresis

high dose oral prednisolone or cyclophosphamide

Question 19

requirements of renal transplant in Goodpastures disease

Answer 19

end stage renal disease
serum anti-GBM antibodies undetectable for 12 mnths
disease remission for 6mnths

Question 20

define minimal change disease

Answer 20

a disease of the kidneys occurring due to minimal histological changes in the nephrons

Question 21

clinical features of minimal change disease

Answer 21

facial swelling that spreads to oedema
nausea + vomiting
abdominal pain
lethargy

Question 22

investigations of minimal change disease

Answer 22

urine dipstick

bloods (FBC, U+Es, LFTs)

Question 23

management of minimal change disease

Answer 23

fluid restriction and ⬇️ salt intake
corticosteroids (prednisolone)
human albumin and furosemide

Question 24

investigation findings in minimal change

Answer 24

+ve protein

Question 25

define membranous glomerulonephritis

Answer 25

the most common type of glomerulonephritis in adults

Question 26

causes of membranous glomerulonephritis

Answer 26

anti-phospholipase A2 antibodies
hepatitis B
malignancy

Question 27

clinical features of membranous glomerulonephritis

Answer 27

oedema of face and legs
recurrent infections
fatigue
SOB

Question 28

investigation findings of membranous glomerulonephritis

Answer 28

basement membrane thickening with subepithelial electron dense deposits
“spike and dome” appearance

Question 29

investigations of membranous glomerulonephritis

Answer 29

bloods (FBC, LFTs, RFTs, lipid and coagulation screen)
urine dipstick
US KUB
CXR + AXR

Question 30

management of membranous glomerulonephritis

Answer 30

ACE inhibitor or ARB

immunosuppression (corticosteroid + cyclophosphamide)