Autoimmune Nephritis

Question 1

1. Proteinuria usually indicates what pathology in the kidney

Answer 1

Decreasing GFR

Question 2

2. When is azotemia indicated

Answer 2

When BUN and serum Creatinine levels increase around 20 – 30 % and GFR falls below 70 ml/min.

Question 3

3. When glomerular filtration rate falls below this level, uremia occurs.

Answer 3

Below 60ml/min

Question 4

4. These are under Primary Glomerulonephritis.

Answer 4

Anti – GBM (Goodpasteur’s disease)
IgA Nephritis
Idiopathic Membranous Nephropathy
Membranoproliferative Nephropathy

Question 5

5. T or F. Secondary Glomerulonephritis are those caused by Diabetes Mellitus, Systemic Lupus Erythematosus and Infection

Answer 5

T

Question 6

6. T or F. Glomerular Nephritic Lesions are characterized by an abundance of leukocytes

Answer 6

T

Question 7

7. T or F. The hallmark of nephrotic syndrome is proteinuria (>3g in 24 hr)

Answer 7

T

Question 8

8. Manifestations of Nephrotic Syndrome

Answer 8

Heavy Proteinuria, Edema, Hyperlipidemia, Lipiduria, Hypoalbuminemia, minimal Hematuria

Question 9

9. Manifestations of Nephritic Syndrome

Answer 9

Hematuria, Hypertension, Low Level Proteinuria, Decreased Urine Output

Question 10

10. Most common clinical sign of Renal Disease

Answer 10

Proteinuria

Question 11

11. Most common cause of primary GN

Answer 11

IgA Nephropathy (Berger Disease)

Question 12

12. Major clinical findings in IgA Nephropathy

Answer 12

Macroscopic Hematuria, Nephrotic Syndrome, Acute Renal Failure
*Most commonly presents with bloody urine that occurs 1 – 3 days after the onset of upper respiratory infection

Question 13

13. A patient with IgA Nephropathy but is normotensive, minimal proteinuria and normal GFR should be assessed after how many months

Answer 13

6 -12 months interval

Question 14

14. Treatment for IgA Nephropathy

Answer 14

ACE Inhibitors/ARBs, they are indicated when the patient develops hypertension and proteinuria (>0.5 g/day)

Question 15

15. T or F. Membranous Nephritis would present mostly as nephrotic syndrome

Answer 15

T

Question 16

16. Histopathologic finding of Membranous Nephritis

Answer 16

Coarse Granular Staining of IgG, due to the deposition of immune complex along the urinary side of the glomerular membrane

Question 17

17. Two types of mesangiocapillary glomerulonephritis

Answer 17

Type 1 – deposition of immune complexes (IgG and C3) subendothelial
Type 2 – dense deposit disease (C3) intramembranous

Question 18

18. This type of mesangiocapillary glomerulonephritis appears diffuse and global in Immunofluorescent studies with mesangial rings and intense staining for C3.

Answer 18

Type 2

Question 19

19. This type of mesangiocapillary glomerulonephritis appears fine to coarse granular and strongly positive for IgG and C3. Lobules appear as negative zone

Answer 19

Type 1

Question 20

20. Anticoagulant is indicated if serum albumin is below this level

Answer 20

<2.5 g/dL and additional risks for thrombosis

Question 21

21. Immunosuppressive agents used in nephrotic/nephritic syndrome

Answer 21

Steroids, mycophenolate, cyclophosphamide, azathioprine

Question 22

22. T or F. Kidney Biopsy is indicated in autoimmune nephritides if the patient has rapidly deteriorating kidney function (doubling of Serum Creatinine over 1 -2 months of observation) in the absence of massive proteinuria (> 15g/dl).

Answer 22

T.
Also done in the development of active urine sediment such as in case of anti – GBM antibody, ANCA and Interstitial nephritis.

Question 23

23. T or F. In Membranous Nephritis and Anti – GBM autoantibodies are directed against the components within the kidneys.

Answer 23

T

Question 24

24. In MPGN and IgAN the autoantibodies are directed against components in the immune system (e.g. C3)

Answer 24

T

Question 25

25. Second most common cause of Chronic Renal Failure

Answer 25

Glomerulonephritis

Question 26

26. Most common cause of kidney failure

Answer 26

DM

Question 27

27. Classification of Azotemia

Answer 27

Pre – renal: decreased perfusion to the kidneys Intra – renal: Primary kidney disease such as acute kidney injury or glomerulonephritis Post – renal: Ureteral Obstruction

Question 28

28. Most common infection – related glomerulonephritis

Answer 28

Post – streptococcal Glomerulonephritis (PSGN)

Question 29

29. PSGN would present as

Answer 29

Presents with hematuria, pyuria, RBC casts, edema, hypertension, oliguric renal failure, and systemic symptoms of headache, malaise, anorexia, and flank pain

Question 30

30. GoodPasture’s or renopulmonary syndrome presents with this pulmonary symptom

Answer 30

Hemoptysis

Question 31

31. A disease wherein patient develops autoantibodies against glomerular basement antigens.

Answer 31

ANTI – GBM (Goodpasture’s/Renopulmonary Syndrome)

Question 32

32. Histopathologic Finding of Goodpasture’s /Renopulmonary Syndrome

Answer 32

Linear straining of IgG along BM with C3 deposition

Question 33

33. Histopathologic Finding of IgA Nephropathy (Berger Disease)

Answer 33

Deposition of IgA in the mesangium, C3 deposition, sometimes IgG & C4

Question 34

34. T or F. Mesangiocapillary glomerulonephritis would show lobular appearance of glomeruli (Proliferating mesangial cells and increased mesangial matrix) and double contour or tram – track appearance (cause by duplication) of basement membrane

Answer 34

T