Glomerular diseases

Question 1

how may glomerular diseases present

Answer 1

acute nephritic syndrome
nephrotic syndrome
asymptomatic urinary abnormalities
CKD

Question 2

5 signs in nephritic syndrome

Answer 2

haematuria
proteiuria
salt and water retention (HTN, oedema, lung creps)
oliguria
uraemia

Question 3

causes of nephritic syndrome

Answer 3

ANY CAUSE OF GLOMERULONEPHRITIS

• systemic diseases
• post strep infection
• Henoch Schon Purp
• viral infections
• bacterial infections e.g. MRSA, syphyllis
• Berger’s disease (IgA nephropathy)

Question 4

viral infections that can cause glomerulonephritis (.,. nephritic syndrome)

Answer 4

eg hep b, mumps, measles, varicella

Question 5

systemic diseases that can cause glomerulonephritis (.,. nephritic syndrome)

Answer 5

• wenger’s granulomatosis
• goodpasture’s disease
• SLE

Question 6

what is glomerulonephritis

Answer 6

range of immune mediated disorders that cause glomerulus inflammation
primary = no other disease elsewhere
secondary = part of a systemic disease e.g. SLE

can cause nephritic OR nephrotic syndrome
which can then lead to CKD…

Question 7

what is minimal change disease and what syndrome does it usually cause? in who?

Answer 7

type of glomerular disease. idiopathic (may be related to immune response)
children 2-4yo (but can occur in adults)
NEPHROTIC SYNDROME (causes 90% of nephrotic syndromes)
don't need to bipsy kids as is always

Question 8

what does minimal change disease show on light microscopy

Answer 8

normal (electron microscopy shows fused podocytes)

Question 9

rx minimal change disease

Answer 9

high dose pred. relapse frequent

Question 10

3 signs of nephrotic syndrome + 1

Answer 10

large proteinuria
hypoalbuminaemia (since all lost in urine)
oedema

+ also hypercholeserolaemia -> hypercoag state!! thrombsosi

Question 11

causes of nephrotic syndrome in adults? what is the most common?

Answer 11

membranous nephropathy (thickening of glomerular basement membrane) - most common

• focal segmental glomerularnephropathy
• minimal change disease

Question 12

what histological classification goes with Berger’s disease (IgA nephropathy)

Answer 12

mesangial proliferative nephritis

Question 13

how does henoch schonlein purpura cause glomerulonephritis (.,. nephritic OR nephrotic syndrome - causes both!)

Answer 13

IgA deposition (same as berger’s)

Question 14

what is diffuse proliferative glomerulonephritis commonly caused by

Answer 14

group a strep infection.

Question 15

what syndrome does strep infection cause and when

Answer 15

acute nephritic syndrome

2 or more weeks after infection

Question 16

rx strep

Answer 16

abx

Question 17

causes of nephrotic syndrome

Answer 17

• minimal change disease
• focal segmental glomerular disease
• membranous glomerular disease

SECONDARY:

• infection HIV, hep b and c
• diabetes
• RA, HSP
• NSAIDs
• malignancy
• pre-eclampsia

Question 18

px nephrotic syndrome children

Answer 18

facial swelling

Question 19

ix if suspected glomerular injury

Answer 19

urine dipstick and microscopy
alb:creat
GFR
FBC, ESR, CRP
U+E
LFT
glucose (diabetes)
antistreptolysin O titre
renal USS
autoantibodies
RENAL BIOPSY (except if v mild or in children)

Question 20

rx nephrotic syndrome

Answer 20

control fluid state -> diuretics
anticoag
statin
prophylactic abx in children

Question 21

most common cause of nephrotic syndrome in children

Answer 21

minimal change disease (always this so don’t need biopsy). nb see quizlet cards - divided into steroid sensitive and steroid resistant

Question 22

how to diagnose the cause of nephrotic syndrome in adults

Answer 22

biopsy

Question 23

what extra ix do you need to do for membranous nephropathy? why?

Answer 23

CT - often paraneoplastic!! :( (but can be autoimmune)

Question 24

usually MCD is treated with steroids. what do you need to be careful of?

Answer 24

relapse on steroid withdrawal - may need calcineurin inhibitor