Nephrotic/nephritic syndromes

Question 1

Clinical consequences of glomerulonephritis

Answer 1

• Dependent on where the inflammation is
• Will then cause presence of protein, blood, wbc, casts in urine
• Failure of the filtration membrane –> AKI
• May or may not lead to scarring - CKD

Question 2

Features of nephrotic syndrome

Answer 2

• Preserved renal function
• Proteinuria > 3g/day
• Spot UPCR or ACR
• > 300mg/mmol or >180mg/mmol
• decreased serum albumin normal 40
• Decreased total protein normal 65
• Oedema

Question 3

Features of nephritic syndrome

Answer 3

• Impaired renal function (rapid or chronic)

- Proteinuria, haematuria, leucosuria

Question 4

GN - presentation symptoms

Answer 4

• Systemic, flu like symptoms
• Rash
• Arthralgia
• Swelling

Question 5

GN - Examination

Answer 5

• Skin
• CVS, oedema
• Chest
• Abdomen
• Urine analysis

Question 6

Urine dip - nephrotic vs nephritic

Answer 6

Nephrotic Nephritic 
Blood       -/+            ++
Protein   +++++         ++
Leucocytes -/+         ++
Nitrites        -              -

Question 7

GN diagnosis - blood tests

Answer 7

• Serum albumin, protein
• Renal function
• Autoimmune screen

Question 8

GN diagnosis - analysis of a renal biopsy

Answer 8

• Light microscopy
• Immuno-histology
• Electron microscopy

Question 9

Minimal change nephrotic syndrome - Associations

Answer 9

• NSAIDS
• Lithium/gold
• Allergy
• Hodgkins

Question 10

What to look for on slides - minimal change nephrotic syndrome

Answer 10

• Epithelial foot processes

Question 11

Minimal change nephrotic syndrome - presentation

Answer 11

• Frothy urine, oedema
• Low albumin
• Preserved function

Question 12

Minimal change nephrotic syndrome - treatment

Answer 12

• Steroids, calcineurin inhibitors (tacrolimus)

- 50% relapse

Question 13

Membranous nephrotic causes

Answer 13

Autoimmune disease
- Lupus, sjorgrens, Rh Arthritis, ank spond, post transplant

Infection
- Hep B, Hep C

Drugs
- Mercury, Captopril, Gold, penicillamine

• Paraneoplastic
• Idopathic

Question 14

Membranous presentation

Answer 14

• Nephrotic syndrome

- AKI/CKD

Question 15

Membranous treatment

Answer 15

• Underlying cause

- Steroids, CNIs, BP

Question 16

Mesangial proliferative GN

Answer 16

Ig A deposition

• Malaria
• Typhoid
• IgA nephropathy

Presentation variable

• Haematuria
• AKI, CKD, hypertensive crisis

Question 17

Diffuse proliferative GN

Answer 17

IgG, IgM, C3 deposition 
Causes 
- Endocarditis 
- Post-streptococcal GN 
AKI, haematuria 
Treat underlying infection

Question 18

Focal segmental glomerulosclerosis causes

Answer 18

Primary - idiopathic

Secondary
Familial - reoccurs after transplantation
Virus - HIV
Drugs - heroin, pamidronate
Obesity, hypertension, atheroemboli, sickle cell anaemia

Question 19

Focal segmental glomerulosclerosis treatment

Answer 19

Primary and familial

• Immunosuppression and BP
• Secondary underlying cause

Question 20

Crescentic GN

Answer 20

ANCA–associated is related to small vessel vasculitis

• granulomatosis with polyangiitis (GPA), Wegener granulomatosis
• microscopic polyangitis (MPA) Churg Strauss

GBM Disease ( Goodpasteurs)
Aggressive IgA nephropathy

Question 21

Treatment options for proliferative crescentic GN

Answer 21

Strict BP control
ACE inhibitors for proteinuria >1g/day
Immunosuppression
- steroids
- cyclophosphamide
- Azathioprine
- mycophenolate mofetil, 
- Rituximab

Question 22

Membranoproliferative/mesangial capillary GN

Answer 22

Primary

Secondary – Hep C, endocarditis, viral infections, malaria, sickle cell disease

Question 23

Treatment options for non-mesangial proliferative GN

Answer 23

Strict BP control
ACE inhibitors for proteinuria >1g/day

Immunosuppression

• steroids
• CNI
• mycophenolate mofetil,
• Rituximab

Question 24

What is glomerulonephritis

Answer 24

Inflammation/proliferation, immune deposits, scarring
BM, Mesangial cells, Podocytes
Infiltration of cells into, Bowmans space,