Glomerulonephritis (GN)

Question 1

define

Answer 1

immune-mediated disease of the kidneys that affects the glomerular capillary wall

Question 2

how do endothelial cells in the glomerulus respond to damage?

Answer 2

vasculitis (haematuria)

Question 3

how do podocytes in the glomerulus respond to damage?

Answer 3

atrophies increasing gap size of barrier leading to proteinuria

Question 4

how does the mesangium in the glomerulus respond to damage?

Answer 4

proliferation and chemokines (haematuria)

Question 5

presentation of GN

Answer 5

haematuria
proteinuria
nephrotic/nephritic syndrome
hypertension

Question 6

classes of proteinuria

Answer 6

microalbuminuria 30-300mg/ day albuminuria
asymptomatic <1g/day
heavy 1-3g/day
nephrotic syndrome 3g/day

Question 7

diagnosis of GN

Answer 7

urinalysis (haematuria, proteinuria, granular casts, RBCs, lipiduria)
kidney biopsy
bloods

Question 8

non-immunosuppressive management of GN

Answer 8

hypertension <130/80 or <120/75 if proteinuria)
ACEI/ARB
diuretics
statins
anticoagulants/ antiplatelets
fish oil

Question 9

immunosuppressive management of GN

Answer 9

corticosteroids
azathioprine
alkylating agents (cyclophosphamide)
calcinuerin inhibitors (cyclosporin)
plasmapheresis (TPE)
antibodies

Question 10

what are granular casts?

Answer 10

precipitation of Tamm-Horsall mucoprotein in low pH

Question 11

types of casts in urine

Answer 11

• hyaline (benign)
• red cells (pathological)
• leucocytes (infection/ inflammation)
• granular (chronic disease)

Question 12

what does presence of RBC casts in urine prove?

Answer 12

haematuria is glomerular

Question 13

main types of idiopathic GN

Answer 13

minimal change
focal segmental glomerulosclerosis (FSGS)
membranous nephropathy
IgA nephropathy
Membranoproliferative
Rapidly progressive GN (RPGN)

Question 14

causes of GN

Answer 14

idiopathic
infection
drugs
systemic (ANCA vasculitis, SLE, Goodpasture’s and HSP)

Question 15

presentation of minimal change

Answer 15

children
facial/generalised oedema
nephrotic proteinuria

Question 16

diagnosis of minimal change

Answer 16

biopsy has minimal change with slight gaps between podocytes

Question 17

management of minimal change

Answer 17

most have complete remission with steroids (PPI for peptic ulceration)

this type does not progress to renal failure

Question 18

causes of FSGS

Answer 18

obesity
HIV
sickle cell
IV drug users

Question 19

presentation of FSGS

Answer 19

commonest cause of nephrotic syndrome in adults

Question 20

diagnosis of FSGS

Answer 20

renal biopsy on LM shows minimal Ig/ complement deposition with podocyte fusion/sclerosis

Question 21

management of FSGS

Answer 21

some have remission with prolonged steroids

can progress to ESRF

Question 22

causes of membranous nephropathy

Answer 22

HepB
parasites
SLE
carcinoma of lung, colon, melanoma, lymphoma
syphilis
NSAIDs
captopril
gold
penicillamine

Question 23

diagnosis of membranous nephropathy

Answer 23

renal biopsy shows immune complex deposition (anti-PLA2r Ab and C3) in BM with thickened membranes on silver stain (spiky)

Question 24

management of membranous nephropathy

Answer 24

steroids
alkylating agents
B cell monoclonal antibody

can progress to ESRF

Question 25

which is the commonest idiopathic GN?

Answer 25

IgA nephropathy

Question 26

presentation of IgA nephropathy

Answer 26

non-nephrotic proteinuria haematuria following respiratory/ GI infection AKI/CKD, Coeliac's, HSP

Question 27

diagnosis of IgA nephropathy

Answer 27

biopsy shows mesangial cell proliferation and IgA deposits in mesangium

Question 28

management of IgA nephropathy

Answer 28

BP control ACEI/ARB fish oil can progress to ESRF

Question 29

causes of membranoproliferative

Answer 29

infection (hep C) SLE malignancy

Question 30

who does membranoproliferative affect?

Answer 30

adults and children

Question 31

presentation of membranoproliferative?

Answer 31

nephritic and nephrotic

Question 32

diagnosis of membranoproliferative

Answer 32

thick membranes= tram tracks

Question 33

define rapidly progressive GN (RPGN)

Answer 33

rapid deterioration of renal function over days/weeks

Question 34

diagnosis of RPGN

Answer 34

active urinary sediment (RBCs, granular casts) | glomerular crescents on biopsy

Question 35

causes of RPGN

Answer 35

``` ANCA positive (GPA, MPA) ANCA negative (Goodpasture's, HSP, SLE) vasculitis ```

Question 36

management of RPGN

Answer 36

immunosuppression (steroids, alkylating agents) plasmapheresis dialysis

Question 37

presentation of nephritic syndrome

Answer 37

``` renal failure (think if high K+) oliguria haematuria oedema hypertension ```

Question 38

diagnosis of nephritic syndrome

Answer 38

active urinary sediment with RBCs and granular casts

Question 39

presentation of nephrotic syndrome

Answer 39

``` proteinuria >3g/day can have normal renal function hypoalbuminuria (facial swelling, low complement- immunosuppressed) oedema hypercholesterolaemia ```

Question 40

complications of nephrotic syndrome

Answer 40

``` infections (loss of antibodies- protein) renal vein thombosis (proteins in clotting cascade) PE volume depletion (diuretics) vitamin D deficiency hypothyroidism ```

Question 41

management of nephrotic syndrome

Answer 41

fluid and Na+ restriction diuretics, ACEI/ARB anticoagulants immunosuppression give pneumococcal vaccine

Question 42

which type is associated with hep B?

Answer 42

membranous

Question 43

which type is associated with hep C?

Answer 43

membranoproliferative