GN

Question 1

Where does HSP appear?

Answer 1

Extensor surfaces, buttocks

Question 2

Nephrotic syndrome

Answer 2

Hypoalbuminaemia
Proteinuria >3g/day
Oedema (peripheral, facial)
Hypercholesterolaemia

Question 3

Nephritic syndrome

Answer 3

Oedema (pulmonary)
AKI
Oliguria
HT
Active urinary sediment (RBCs, granular casts, proteinuria)
- Post strep GN

Question 4

GN can present in 2 ways:

Answer 4

Chronic GN - most common cause of ESRF after diabetes

Acute GN - treatable cause of AKI

Question 5

How is the glomerulus damaged?

Answer 5

Immune mediated with secondary tubulointerstitial damage
Humoral mediated - antibodies
Cell mediated - T cells, inflamm cells, complement

Question 6

Damage to endothelial or mesangial cells leads to:

Answer 6

Proliferative lesion

Haematuria

Question 7

Damage to epithelial or podocytes leads to:

Answer 7

Non-proliferative lesion

Proteinuria

Question 8

Diagnosis of GN

Answer 8

Clinical
Bloods
Urinalysis
Urine microscopy - casts, RBCs
Urine protein:creatinine ratio
Biopsy

Question 9

Microalbuminuria

Answer 9

30-300mg/day

Question 10

Asymptomatic proteinuria

Answer 10

Less than 1g/day

Question 11

Heavy proteinuria

Answer 11

1-3g/day

Question 12

Nephrotic proteinuria

Answer 12

More than 3g/day

Question 13

Dysmorphic RBCs

Answer 13

From UUT

Red cells escaping GBM = squished

Question 14

Isomorphic RBCs

Answer 14

From LUT

Round

Question 15

Red cell casts

Answer 15

Always pathological

Nephritic syndrome

Question 16

Is nephrotic syndrome proliferative or non-proliferative?

Answer 16

Non-proliferative = proteinuria

Damage to podocytes/epithelium

Question 17

Complications of nephrotic syndrome

Answer 17

Infection
Renal vein thrombosis
PE
Volume depletion
Vit D deficiency
Sub-clinical hypothyroid

Question 18

Is nephritic syndrome proliferative or non-proliferative?

Answer 18

Proliferative = haematuria

Damage to endothelium/mesangial cells

Question 19

Focal GN

Answer 19

less than 50% affected

Question 20

Diffuse GN

Answer 20

> 50% affected

Question 21

Global GN

Answer 21

All of glomerulus affected

Question 22

Segmental GN

Answer 22

Part of glomerulus affected

Question 23

Crescents

Answer 23

Extra-capillary proliferation of inflammatory cells in Bowman’s space, e.g. RPGN in vasculitis, due to break in GBM from ANCA = compression and ischaemia

Question 24

Non immunosuppressive treatment of GN

Answer 24

Anti-HT (aim for 130/80 or 120-75 for proteinuria)
ACEI/ARB
Diuretic
Statin
Anticoag/aspirin
Omega 3/fish

Question 25

Immunosuppressive treatment of GN

Answer 25

Steroids Azathioprine Alkylating agents (cylcophosphamide/chlorambucil) Calcineurin inhibitors (tacrolimus/cyclosporin) Mycophenolate Plasmapheresis IV IG, MABs

Question 26

Treatment of nephrotic syndrome

Answer 26

``` Fluid and salt restriction Diuretic ACEI/ARB Anticoagulant IV albumin (if low volume) Steroids + another immsup agent ```

Question 27

Types of primary idiopathic GN

Answer 27

``` Minimal change GN FSGS Membranous GN Membranoproliferative GN IgA nephropathy RPGN ```

Question 28

Minimal change GN

Answer 28

Commonest cause of nephrotic syndrome in kids Non-proliferative - podocyte side Does NOT cause progressive renal failure IL-13

Question 29

Biopsy of minimal change GN

Answer 29

Normal on LM and IF | Foot process fusion on EM

Question 30

Treatment of minimal change GN

Answer 30

Steroids | Cyclophosphamide/MAB

Question 31

FSGS

Answer 31

Commonest cause of nephrotic syndrome in adults Primary (most common) or secondary to HIV/heroin/obesity/reflux Non-proliferative - podocyte side 50% progress to ESRF after 10 years suPAR

Question 32

Biopsy of FSGS

Answer 32

FSGS on LM Ig/Complement deposition on IF Podocyte effacement

Question 33

Treatment of FSGS

Answer 33

Steroids | LT calcineurin inhibitors

Question 34

Membranous GN

Answer 34

2nd commonest cause of nephrotic syndrome in adults Primary or secondary to Hep B/carcinoma/lymphoma/SLE/CTD 30% progress to ESRF after 10 years Anti-PLA2r Ab Non-proliferative = podocytes

Question 35

Biopsy of Membranous GN

Answer 35

Immune complex deposition in basement membrane on LM | Thickened BM

Question 36

Treatment of Membranous GN

Answer 36

Steroids Alkylating agents (cyclophosphamide) MABs

Question 37

IgA nephropathy

Answer 37

``` Commonest GN in the world Broad spec (microhaematuria and ```

Question 38

What is IgA nephropathy associated with?

Answer 38

Colitis, arhtritis, HSP

Question 39

Biopsy of IgA nephropathy

Answer 39

Mesangial cell proliferation and expansion on LM IgA deposits in meseangium on IF Increased inflammatory cells

Question 40

Treatment of IgA nephropathy

Answer 40

BP control ACEI/ARB Fish oil

Question 41

RPGN

Answer 41

Treatable cause of AKI Rapid deterioration over days/weeks Urinary sediment (RBCs, casts) and crescents

Question 42

ANCA positive RPGN

Answer 42

Vasculitis GPA MPA

Question 43

ANCA negative RPGN

Answer 43

Goodpasture's HSP SLE

Question 44

Treatment of RPGN

Answer 44

Prompt immunosuppression: steroids, aza/cyclophosphamide/mycophenolate, MAB Plasmapheresis Supportive dialysis