Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

4th Year Gen Med > Renal - Glomerulopathies > Flashcards

Renal - Glomerulopathies Flashcards

1
Q

What is the most common cause of nephrotic syndrome in children?

A

Minimal change disease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

List some of the features of nephritic syndrome?

A

Haematuria (macro or micro)
Proteinuria
Oliguria
Fluid retention

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What is the criteria a patient must fulfil to have nephrotic syndrome?

A

Peripheral oedema
Proteinuria of >3g in 24 hours
Serum albumin of <25g per litre (hypoalbuminemia)
(Can also present with or have the complication of hypercholesterolemia)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

List the different types of glomerulonephritis:

A 
Minimal change disease
IgA nephropathy  (aka Berger's disease or mesangioproliferative)
Goodpasture syndrome
Membranous glomerulonephritis
Focal segmental glomerulosclerosis
Mesangiocapillary glomerulonephritis
Rapidly progressive glomerulonephritis 
Post streptococcal (aka diffuse proliferative)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Define interstitial nephritis:

A

Inflammation of the space between the tubules (interstitium) and the cells of the kidney.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What are the two different forms of interstitial nephritis:

A

Acute interstitial nephritis

Chronic Tubulointerstitial nephritis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Which types of glomerulonephritis tend to present with nephritic syndrome symptoms?

A

IgA
Rapidly progressive
Alport’s syndrome

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

A male patient presents with some of the following symptoms:
microscopic haematuria and progressive renal failure
bilateral sensorineural deafness
lenticonus, retinitis pigmentosa
What is the likely diagnosis?

A

Alport’s syndrome

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

How is Alport’s syndrome diagnosed?

A

Genetic testing

Renal biopsy:
electron microscopy: characteristic finding is of the longitudinal splitting of the lamina densa of the glomerular basement membrane, resulting in a ‘basket-weave’ appearance

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What is the mode of inheritance in Alport’s syndrome?

A

Autosomal dominant

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Alport’s syndrome is caused by a defect in collagen type ? which leads to defective basement menbranes.

A

4

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

List the glomerulonephritides which cause nephrotic syndrome:

A 
Focal segmental
Membranous
Minimal change
Diabetic
Amyloidosis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

List the glomerulonephritides which can cause a mixture of nephritic and nephrotic syndrome?

A

Post streptococcal
Diffuse proliferative
Membranoproliferative

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What is the most common type of glomerulonephritis in adults?

A

Membranous

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

At what age does membranous glomerulonephritis peak?

A

20’s and 60’s

There is a bimodal peak

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What is the main symptom associated with membranous GN?

A

Proteinuria

A lot tend to be asymptomatic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

List some of the main causes of membranous GN?

A

Idiopathic (>70%)

Infection
NSAIDs
Malignancy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What is the main course of management for Membranous GN?

A

30% will resolve on their own

All should receive either an ACE inhibitor or an ARB

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What are the two main principles of management in any glomerulonephritis?

A

Steroids (immunosuppression)

ACE inhibitors or ARBs to control BP

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What can nephrotic syndrome predispose a patient to?

A 
Thromboembolism
Hypertension
Hypercholesterolemia
Increased risk of infections
Hypocalcemia
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Loss of what substance can lead to the development of thrombus in patients with nephrotic syndrome?

A

Antithrombin III

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Which form of glomerulonephritis is the most common cause of nephrotic syndrome in adults?

A

Focal segmental glomerulosclerosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

What are the main causes of minimal change disease?

A

Mainly idiopathic

Others include:
Hodgkin's lymphoma
Thymoma
NSAIDs &amp; rifampicin
Infectious mononucleosis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Why are patients with nephrotic syndrome more predisposed to infections?

A

There is a decrease in serum IgG levels and complement as well as a decreased T cell funciton

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

What does minimal change disease look like under:
Light Microscopy
Electron microscopy

A

Light : minimal change (hence name)

Electron: Podocyte foot process effacement

26
Q

What are the main principles of treatment for nephrotic syndrome?

A

Reduce oedema
Reduce proteinuria
Reduce risk of complications e.g. anticoagulate
Treat underlying cause

27
Q

Injury to what cell type in the kidney leads to high loss of protein and why?

A

Podocytes
They wrap around the glomerular capillaries and maintain the filtration barrier. when damaged there is a high excretion of protein

28
Q

What changes are seen on histology in membranous glomerulonephritis?

A

Diffusely thickened glomerular basement membrane with IgG and complement deposits

29
Q

What antibodies are found in up to 80% of patients with idiopathic membranous glomerulonephriits?

A

Anti-phospholipase A2 antibodies

30
Q

Berger’s disease is another name for what?

A

IgA nephropathy

31
Q

Which GN is the most common cause of primary glomerular nephropathy worldwide?

A

IgA nephropathy

32
Q

What changes will be seen in a patient with IgA nephropathy?

A

Proliferative changes within glomerular mesangial cell with mesangial deposition of IgA

33
Q

A male patient presents with macroscopic haematuria following an URTI only a few days ago, what is the most likely diagnosis?

A

IgA nephropathy (Bergers)

34
Q

What % of patients with IgA nephropathy will go on to develop end stage renal failure?

A

25%

35
Q

A renal biopsy taken from a young male shows the following:
acute, diffuse proliferative glomerulonephritis
endothelial proliferation with neutrophils
electron microscopy: subepithelial ‘humps’ caused by lumpy immune complex deposits
immunofluorescence: granular or ‘starry sky’ appearance. What is the likely diagnosis?

A

Post streptococcal nephropathy

36
Q

What is another name for post streptococcal glomerulonephritis?

A

Diffuse proliferative glomerulonephritis

37
Q

What are some of the common features of a post streptococcal GN?

A

Usually under 30 y/o
Presenting 1-3 weeks post URT infection (tonsillitis)
Nephritic syndrome symptoms

38
Q

What levels will be low in post streptococcal GN?

A

Complement

39
Q

What immune complexes are deposited in the glomeruli in a post streptococcal GN?

A

Complement (C3)
IgG
IgM

40
Q

What mode of inheritance is seen in Alport’s syndrome?

A

X linked (dominant / recessive)

41
Q

What is the difference between a glomerulonephritis and a glomerulopathy?

A

Glomerulonephritis - inflammation of the glomeruli can be seen
Glomerulopathy - no evidence of inflammation can be seen

42
Q

How should minimal change GN be managed?

A

High dose corticosteroid e.g. prednisalone for 4-6 weeks IF patient has significant proteinuria. Can be withheld for spontaneous remission
Up to 2/3rds will require further courses due to relapsing or non remittance

43
Q

How does focal segmental glomerulosclerosis present typically?

A

Massive proteinuria
Renal impairment
Hypertension
Haematuria

44
Q

Where is the kidney is typically affected first by focal segmental glomerulosclerosis?

A

The deep glomeruli of the corticomedullary junction

45
Q

WHat is seen on light microscopy for focal segmental glomerulosclerosis?

A

Segmental sclerosis is seen first. Then progresses to global sclerosis
Hyalinosis also seen

46
Q

What deposits will be seen on immunofluorescence in focal segmental glomerulosclerosis?

A

C3 and IgM

47
Q

What are the main causes of focal segmental glomerulosclerosis?

A 
Idiopathic
Secondary to other renal pathology e.g. IgA nephropathy, minimal change disease
HIV
Heroin abuse
Sickle cell
Alport's
48
Q

How is FSGS treated?

A

<10% will go through spontaneous remission
Prednisolone (6 months)
+/- immunosuppressant e.g. ciclosporin

49
Q

Define azotaemia?

A

This is a collection of biochemical abnormalities including a raised blood urea, nitrogen and creatinine
often just referred to as uraemia

50
Q

In diabetic nephropathy the kidneys shrivel and get smaller. True or false?

A

False

They bilaterally enlarge and initially will have hyperfiltration

51
Q

What histological changes can be seen from early on in diabetic nephropathy?

A

Basement membrane thickening and mesangial expansion

52
Q

What is the most common cause of glomerular pathology and CKD in the UK?

A

Diabetic Nephropathy

53
Q

What causes the scarring in diabetic nephropathy?

A

The high concentration of glucose passing through the kidneys

54
Q

How are diabetics screened for diabetic nephropathy?

A

Albumin:creatinine ratio

Us and Es for kidney function

55
Q

What medication is first line for hypertension management in diabetic patients?

A

ACE inhibitors (or ARBs if not well tolerated)

56
Q

What form of glomerulonephritis is rarer, but has a significantly poor prognosis and is sometimes associated with hep C?

A

Membranoproliferative GN

57
Q

A patient presents with pulmonary haemorrhage (haemoptysis) and acute glomerulonephritis. What is the likely diagnosis?

A

Goodpasture’s disease a.k.a anti-glomerular basement membrane GN

58
Q

Anti-GBM / Goodpasture’s disease is a form of _______ glomerulonephritis?

A

Rapidly progressive

59
Q

How is Goodpasture’s disease managed?

A

Plasma exchange
Steroids
Cyclophosphamide

60
Q

Histology from a renal biopsy shows crescentic glomerulonephritis in an acutely unwell patient. What is the diagnosis?

A

Rapidly progressive GN

61
Q

What causes the crescentic shape in rapidly progressive GN?

A

An aggregate of macrophages and epithelial cells in the Bowman’s space

4th Year Gen Med (10 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions