updated glomerulonephritis

Question 1

in hematuria associated with glomerulonephritis what is special about the RBCs ?

Answer 1

abnormal shape and can show acanthocytes ( RBC budding) due to gglomerular cause

Question 2

what is seen on macroscopic examination of urine that indicated proteinuria ?

Answer 2

frothy urine

Question 3

if there is injury to the podocytes what is the presentation ?

Answer 3

proteinuria ( nephrotic )

Question 4

if there is injury to the mesangial or endothelial cells what is the presentation ?

Answer 4

hematuria - nephritic

Question 5

if there are breaks in the GBMM what is the presentation ?

Answer 5

hematuria - neephritic

Question 6

what are the glomerular diseases generally divided into ?

Answer 6

asymptomatic proteinuria
asymptomatic hematuria
nephritic syndrome
nephrotic syndrome
macroscopic hematuria
rapidly progressive glomerulonephritis
chronic glomerulonephritis

Question 7

what are the different etiologies for glomerular injury ?

Answer 7

antigen antibody complex
complement activation
t-lymphocytes
genetics

Question 8

what is the difference between nephritic and nephrotic syndrome ?

Answer 8

nephritis - associated with hematuria, mild proteinuria
nephrotic - proteinuria above 3.5 mg/dl , hypoalbuminemia , oedema and ascites

Question 9

hypertension is associated with nephritic or nephrotic ?

Answer 9

nephritic more commonly

Question 10

what are the main characteristics of nephrotic syndrome ?

Answer 10

proteinuria above 3.5 mg/dll
hyperlipidemia
lipiduria
hypercoagulability - due. to loss of anticoagulants
ascites
generalized oedema - ascites , pleural effusion

Question 11

how can nephrotic syndrome cause acute kidney injury ?

Answer 11

1- drugs that are used to treat nephrotic can cause AKI
2- renal vein thrombosis
3- no osmotic pressure due to lack of albumin, which causes pre renal AK if left for too long can cause ATN

Question 12

what is rapidly progressive glomerulonephritis ?

Answer 12

similar to nephritic but kidney function loss happens over a week

Question 13

what is the treatment for glomerular disease from a general supportive aspect ?

Answer 13

adequate dietary protein intake
ACE inhibitors or ARBS
loop diuretics
dietary sodium restriction

Question 14

what is the goal for blood pressure in patients with glomerular disease ?

Answer 14

below 130/80

Question 15

what is rapidly progressive glomerulonephritis characterized by ?

Answer 15

formation of crescents and hematuria with red cell casts ( which is also seen in nephritic)

Question 16

what are the diseases that fall under the band off nephrotic syndrome ?

Answer 16

minimal change disease
focal segmental glomerulosclerosis
membranous nephropathy
amyloidosis
diabeticc nephropathy

Question 17

what are the diseases that fall under the band off nephritic syndrome ?

Answer 17

acute diffuse proliferative glomerulonephritis ( Acute post-streptococcal glomerulonephritis
Lupus proliferative glomerulonephritis )
IgA nephropathy
Alport syndrome

Question 18

what are the types of rapidly progressive glomerulonephritis ?

Answer 18

type 1 : goodpasture syndrome
type 2 : immune complex mediated glomerulonephritis
type 3: ANCA associated vasculitis

Question 19

what disease falls under mixed nephritic and nephrotic syndrome ?

Answer 19

membranoproliferative glomerulonephritis

Question 20

what is the cause of post streptococcal glomerulonephritis ?

Answer 20

chest or skin infection ( group b hemolytic streptococcal infection ) , affecting the sub epithelials area

Question 21

what is the clinical presentation for acute post streptococcal GN ?

Answer 21

nephritic syndrome which present 1-4 weeks after a streptococcal infection ( sore throat or skin infection )

Question 22

what age group is commonly associated with post strep GN ?

Answer 22

young children

Question 23

what are the specific investigations for post strep GN ?

Answer 23

antistreptolysin O titre
ASOT

Question 24

what is the clinical presentation of SLE proliferative GN ?

Answer 24

if the patient presents with :
nephrotic - membranous nephropathy
nephritic - lupus proliferative GN
mixed - MPGN

Question 25

what are the specific investigations for SLE proliferative GN ?

Answer 25

detection of autoantibodies : anti-dsDNA Anti-smith ANA

Question 26

what is the cause of IgA nephropathy ?

Answer 26

after a respiratory tract or GIT infection abnormal Ig formation occurs which then acts as the antigen

Question 27

what is the CP of IgA nephropathy ?

Answer 27

recurrent attacks of nephritic syndrome or macroscopic haematuria 1-2 days after thee infection and usually occurs in older patients

Question 28

what disease is IgA nephropathy associated with ?

Answer 28

Celiac disease

Question 29

what is the specific investigation for IgA nephropathy ?

Answer 29

elevated serum IgA

Question 30

what is the cause of Alports syndrome ?

Answer 30

x linked hereditary disease mutation in type 4 collagen of the basement membrane

Question 31

what is the clinical picture of alports syndrome ?

Answer 31

nephritic syndrome recurrent attacks of macroscopic hematuria sensorineural deafness ocular abnormalities

Question 32

what are the different causes of minimal change disease ?

Answer 32

primary : abnormal T lymphocyte activity secondary : respiratory tract infections atopy immunizations hodgkin's lymphoma NSAID therapy in adults

Question 33

what is the clinical presentation of MCD ?

Answer 33

nephrotic syndrome , and primary is more commonly seen in children

Question 34

what is thee treatment for 1ry and 2ry MCD ?

Answer 34

1ry MCD : immunosuppressive drugs , first line corticosteroids 2rry MCD : treat the cause - no immunosuppressive

Question 35

what is the cause of primary focal segmental glomerulosclerosis ?

Answer 35

abnormal T lymphocyte activation may also be hereditary

Question 36

what are the causes of secondary FSGS ?

Answer 36

HIV Heroin pamidronate - drugs for osteoporosis interferon

Question 37

what is the effect of circulating permeability factors ?

Answer 37

damage to the podocytes , causing effacement and hence nephrotic syndrome

Question 38

what are the causes of primary membranous nephropathy ?

Answer 38

immune complex formation

Question 39

what are the causes of secondary membranous nephropathy ?

Answer 39

malignancy HBV , HCV , HIV SLEE drugs : NSAIDs, penicillamine

Question 40

what is the clinical picture of membranous nephropathy ?

Answer 40

nephrotic syndrome

Question 41

what is different about the presentation of membranoproliferative GN ?

Answer 41

present with nephrotic and nephritic proteinuria of more than 3.5 , edeema, hematuria and hypertension

Question 42

what are the secondary causes of secondary membranoproliferative GN ?

Answer 42

HCV, HBV SLE plasma cell dyscrasias - like multiple myelomas

Question 43

what is the cause of goodpasture disease ?

Answer 43

auto antibodies against alpha 3 chain of type 4 collagen off thee GBM and alveolus BM

Question 44

what is the clinical presentation of goodpasture syndrome ?

Answer 44

rapidly progressive GN ( crescent formation ) pulmonary hge and hemoptysis

Question 45

what is the other name for good pasture's disease ?

Answer 45

anti GBM disease

Question 46

what is the treatment for good pastures disease ?

Answer 46

immunosuppressive and plasma exchange

Question 47

what is the specific investigation for goodpasture's disease ?

Answer 47

anti-GBM antibodies

Question 48

what are the three different types of RPGN ?

Answer 48

type I : good pasture type II : immune complex mediated GN type III : ANCA associated vasculitis

Question 49

what is the prognosis for acute post strep GN ?

Answer 49

self-limiting , associated with full renal recovery

Question 50

what is the prognosis of minimal change disease ?

Answer 50

corticosteroids are effective in remission relapse is common

Question 51

what is the prognosis for alport and FSGS ?

Answer 51

almost all cases progress to chronic kidney failure

Question 52

what is the prognosis of RPGN ?

Answer 52

renal function deteriorates rapidly and is often irreversible

Question 53

what is the prognosis for IgA and MPGN ?

Answer 53

50% will progress to CKD over time

Question 54

what is the prognosis for membranous nephropathy ?

Answer 54

25% of cases are resistant to therapy and progress to CKD 75 % off cases enter remission

Question 55

what is the prognosis of lupus diffuse proliferative GN ?

Answer 55

outcomes are variable

Question 56

generally do nephrotoxic drugs cause nephritic or nephrotic ?

Answer 56

nephrotic

Question 57

what is the difference between acute post strep glomerulonephritis and IgA nephropathy ?

Answer 57

post strep - presents with nephritic present 1-4 weeks after infection of the skin or throat and usually occurs in children IgA nephropathy - recurrent attacks of nephritic syndrome or macroscopic hematuria presents 1-2 days after GIT or resp tract infection and is seen in older patients

Question 58

what is the treatment for post strep GN ?

Answer 58

treat with antibiotics

Question 59

what specific investigation can be ordered for a patient with alports ?

Answer 59

genetic testing

Question 60

Is there any role for testing or investigating other family members? If yes, what investigations would you request for patients with alport's ?

Answer 60

family members should be screened for hematuria

Question 61

what is the most common nephrotic disease in children ?

Answer 61

minimal change nephropathy

Question 62

why are patients with nephrotic syndrome more prone for thromboembolic events ?

Answer 62

* Risk of thromboembolic events due to decreased levels of natural anticoagulants (due to urinary losses) such as: a. anti-thrombin III b. Plasminogen c. protein C and S * Avoid thromboembolic events by using prophylactic anticoagulation with heparin, warfarin.