Glomerulonephritis

Question 1

general features of glomerulonephritis? (4)

Answer 1

haematuria
proteinuria
hypertension
renal insufficiency

Question 2

haematuria in glomerulonephritis?

Answer 2

persistent microscopic haematuria with dysmorphic RBss

Question 3

proteinuria in glomerulonephritis?

Answer 3

persistent proteinuria

Question 4

what does it mean by renal insufficiency?

Answer 4

rising creatinine

Question 5

what is the characteristics of nephrotic syndrome? (4)

Answer 5

hypoalbuminemia
hyperlipidemia
oedema
proteinuria (>3.5g/day)

Question 6

difference between diffuse and focal ?

Answer 6

diffuse >50% glomeruli affected

focal <50% glomeruli affected

Question 7

post-streptococcal glomerulonephritis?

Answer 7

10-21 days after throat or skin infection
most common is Lancefield Group A Streptococci
treat: frusemide, vasodilation for HT, antibiotics

Question 8

IgA nephropathy?

Answer 8

commonest cause of glomerulonephritis
IgA deposition in the mesangium with mesangial proliferation
common in 20/30s and males

Question 9

presentation of IgA nephropathy?

Answer 9

microscopic haematuria
proteinuria
nephrotic syndrome
IgA crescentic glomerulonephritis

Question 10

crescentic glomerulonephritis? (3)

Answer 10

ANCA-associated
anti-GBM
others: IgA vasculitis, SLE..

Question 11

Anti-GBM disease?

Answer 11

rare caused by circulating anti glomerular basement membrane (anti-GBM)
two peaks: 3rd and 6/7th decade

Question 12

diagnosis in Anti-GBM disease?

Answer 12

anti-GBM antibodies in serum and kidney

Question 13

Anti-GBM disease presentation?

Answer 13

nephritis

nephritis plus lung haemorrhage

Question 14

Anti-GBM disease treatment?

Answer 14

aggressive immunosuppression: steroid, plasma exchange and cyclophosphamide

Question 15

nephrotic syndrome management (5)?

Answer 15

treat oedema
treat HT
thrombosis risk - heparin/warfarin
statins
reduce infection risk (vaccines)

Question 16

minimal change nephrotic syndrome?

Answer 16

commonest form in children
sudden onset of oedema
complete loss of proteinuria with steroids
2/3rd patients relapse

Question 17

minimal change nephrotic syndrome treatment?

Answer 17

prednisolone then taper off then repeat for initial relapse
any subsequent relapse: cyclophosphamide, cyclosporin, tacrolimus, mycophenolate mofetil

prognosis favourable but careful for steroid toxicity

Question 18

membranous nephropathy? causes?

Answer 18

commonest cause of nephrotic syndrome in adults

majority idiopathic, some malignancy, SLE, arthritis

Question 19

membranous nephropathy serological marker?

Answer 19

anti-phospholipase A2 receptor (PLA2R)

Question 20

membranous nephropathy treatment?

Answer 20

general measures for at least 6 months
immunosuppression if symptomatic
cyclophosphamide and steroids in alternative months for 6 months

Question 21

IgG glomerulonephritis?

Answer 21

IgG deposits itself between the basal lamina and podocyte, it is too big to filter into urine but activated complement C3 which punches holes in the filter which allows albumin to leak and nephrotic syndrome

1/4 in renal failure within 10 years

Question 22

Crescentic glomerulonephritis?

Answer 22

granulomatosis with polyangitis
microscopic polyarteritis
anti-GBM changes

Question 23

Crescentic glomerulonephritis test?

Answer 23

Wegeners test with serum showing presence of anti-neutrophil cytoplasmic antibodies (ANCA)

Question 24

what are ANCA directed at?

Answer 24

proteinase 3 and myeloperoxidase

Question 25

Crescentic glomerulonephritis prognosis?

Answer 25

fatal if left untreated

cyclophosphamide - 75% complete remission