Glomerular nephritis

Question 1

Define nephritis

Answer 1

A generic term that means inflammation of the Kidneys

Question 2

What is nephritic syndrome

Answer 2

A group of symptoms indicating that inflammation has caused damage to the kidneys.

Question 3

What are the symptoms of Nephritic syndrome

Answer 3

Haematuria
Oliguria
Proteinuria (mild/moderate <3.5g/l/day)
Fluid Retention

Question 4

What can be found in the active urine sediment in nephritic syndrome

Answer 4

Haematuria
Dysmophic RBC
Cellular casts

Question 5

What are cellular casts

Answer 5

Urinary casts are tiny tube-shaped particles that can be found when urine is examined under the microscope during a test called urinalysis.

Urinary casts may be made up of white blood cells, red blood cells, kidney cells, or substances such as protein or fat. The content of a cast can help tell your health care provider whether your kidney is healthy or abnormal.

Question 6

What is the main feature of someone in the nephritic state

Answer 6

Haematuria

Question 7

What is the pathophysiology of a nephritic syndrome

Answer 7

Neutrophils attack the basement membrane of glomerulus and podocyte processes. The triple flltration barrier is disrupted causing spillage

Question 8

What is nephrotic syndrome

Answer 8

Nephrotic syndrome is a condition involving the loss of significant volumes of protein via the kidneys (proteinuria) which results in hypoalbuminaemia.

Question 9

What are the group of symptoms the nephrotic state

Answer 9

Peripheral oedema
Proteinuria (frothy urine)
Serum Albumin low (hypoalbuminuria)
Hypercholesterolaemia 
Fatigue 
Poor appetite
Recurrent infections
Venous/arterial thrombosis

Question 10

What is the most noticeable feature of nephrotic syndrome

Answer 10

The proteinuria

Question 11

How high does the protein content in the urine need to be to call it proteinuria

Answer 11

> 3.5g in 24 hrs

Question 12

How low does the albumin content of the blood need to be to call it hypoalbuminuria

Answer 12

<35g per litre

Question 13

Is there more oedema in nephritic or nephrotic syndrome

Answer 13

Nephrotic

Question 14

Why do you get oedema in the nephrotic state

Answer 14

Reduced oncotic pressure

excessive sodium

Question 15

What is the pathophysiology of nephrotic state

Answer 15

The podocytes shrink making them come apart and spill. Also get some thickening of the basement membrane.

Question 16

How would you treat oedema in nephrotic syndrome

Answer 16

Salt/fluid restriction and loop diuretics

Question 17

How would you treat hypertension in nephrotic syndrome

Answer 17

Renin-angiotensin-aldosterone blockade

Question 18

How would you reduce risk of thrombosis in nephrotic syndrome

Answer 18

Heparin/warfarin

Question 19

How would you reduce risk of infection in nephrotic syndrome

Answer 19

Pneumaccocal vaccine

Question 20

How would you treat dyslipidaemia in nephrotic syndrome

Answer 20

Statins

Question 21

What medications can cause nephrotic syndrome

Answer 21

NSAIDS
Penicilline
Interferon
Captopril

Question 22

What is glomerular nephritis

Answer 22

Inflammation of or around the glomerulus

Question 23

What are the sub-types of glomerulonephritis

Answer 23

Proliferative

Non-Proliferative

Question 24

What is characteristic of proliferative glomerulonephritis

Answer 24

Lots of cells in the the glomeruli , including infiltrating leukocytes

Question 25

What is charecteristic of non-proliferative glomerulonephritis

Answer 25

Glomeruli looks normal or has areas of scarring. There are normal numbers of cells present

Question 26

If the non-proliferative glomerulonephritis is diffuse what does that means

Answer 26

>50% of glomeruli affected

Question 27

If the non-proliferative glomerulonephritis is focal what does that means

Answer 27

<50% glomeruli affected

Question 28

If the non-proliferative glomerulonephritis is global what does that means

Answer 28

All of glomerulus affected

Question 29

If the non-proliferative glomerulonephritis is segemental what does that means

Answer 29

Part of glomerulus is affected

Question 30

What are the Proliferative glomerulonephritises

Answer 30

IgA nephropathy Post streptococcal glomerulonephritis Crescentic Glomerulonephritis Membranoproliferative Glomerulonephritis

Question 31

What does IgA nephropathy show on histology

Answer 31

IgA deposits and glomerular Mesangial proliferation

Question 32

What is the presentation of IgA nephropathy

Answer 32

Microscopic haematuria Microscopic proetinuria Nephritic syndrome

Question 33

What age in IgA nephropathy most common

Answer 33

In 20s

Question 34

What sex is IgA nephropathy more common

Answer 34

Males

Question 35

Is IgA nephropathy common?

Answer 35

Yes - its the most common cause of primary glomerulonephritis.

Question 36

What is the age range for post infectious glomerulonephritis

Answer 36

Under 30 years old

Question 37

What infection is post infectious glomerulonephritis common after

Answer 37

Lancefield group A streptococci

Question 38

What syndrome for post infectious glomerulonephritis develop

Answer 38

Nephritic

Question 39

What is the prognosis like for post infectious glomerulonephritis

Answer 39

Usually get a full recovery

Question 40

What can cause crescentic glomerulonephritis

Answer 40

Anti-neutrophil cytoplasmic antibody (anca) associated Anti-glomerular basement membrane Others

Question 41

what are the subtypes of Anti-neutrophil cytoplasmic antibody (anca) associated

Answer 41

Microscopic polyangiitis Granulomatosis with polyangitits Eosinophilic granulomatosis with polyangitis.

Question 42

What is Granulomatosis with polyangitits

Answer 42

Granulomatosis with polyangiitis (GPA) is a rare condition where the blood vessels become inflamed. It mainly affects the ears, nose, sinuses, kidneys and lungs. Anyone can get it, including children, but it's most common in adults and older people

Question 43

What is Good pastures syndrome

Answer 43

Anti-glomerular basement membrane nephritis with lung haemorrhage.

Question 44

What happens in Anti-glomerular basement membrane disease

Answer 44

Antibodies attack the basement membrane in the lungs and kidneys leading to bleeding from the lungs, glomerulonephritis and kidney failure.

Question 45

What % of crescentic GN is v caused by Anti-glomerular basement membrane

Answer 45

10-20%

Question 46

What is treatment for Anti-glomerular basement membrane disease

Answer 46

Aggressive immunosuppression Steroids Plasma exchange and cyclophosphamide.

Question 47

What are the non-proliferative glomerulonephritis

Answer 47

Minimal change disease Focal and Segmental glomerulonephritis Membranous nephropathy

Question 48

What age group is minimal change disease common

Answer 48

Children

Question 49

What is presenting symptoms of minimal change disease

Answer 49

Sudden onset of Oedema

Question 50

Histologically what is observed in minimal change disease

Answer 50

Not much seen on light microscopy No immunodeposits Podocytes are shrunken with smaller processes that are less interdigitated.

Question 51

What is treatment for minimal change disease

Answer 51

Prednisolone (1mg/kg) for up to 16 weeks

Question 52

What do you treat an intial relapse with in minimal change disease

Answer 52

Prednisolone

Question 53

What do you treat an 2nd and subsequent relapse with in minimal change disease

Answer 53

Cyclophosphamide Cyclosporin Tacrolimus Rituximab

Question 54

What is the prognosis for minimal change disease

Answer 54

Favourable, despite the relapsing nature of the condition.

Question 55

What is focal/segmental glomerulonephritis

Answer 55

A syndrome describing a sclerosis of the kidney presenting with Nephrotic syndrome

Question 56

How do you treat focal/segmental glomerulonephritis

Answer 56

Steroids (but they dont usually work) | Cyclosporin, Cyclophosphamide, Rituximab

Question 57

What is the main cause of membranous nephropathy

Answer 57

Usually ideopathic

Question 58

Is membranous nephropathy common?

Answer 58

Its the most common nephrotic syndrome in adults

Question 59

How do you identify membranous nephropathy

Answer 59

Serological markers: Anti phospholipase A2 receptor (PLA2r) - +ve in 70% cases Thrombospondin type 1 domain in 2%

Question 60

What are less common causes of membranous nephropathy

Answer 60

Malignancies SLE Rheumatoid arthritis Drugs: NSAID, Gold, Penicillamine

Question 61

What is treatment for membranous nephropathy

Answer 61

General measures...? for 6 monthes | immunosupression

Question 62

Wheh should you use immunosuppresion in membranous nephropathy

Answer 62

If symptomatic nephrotic syndrome with rising proteinuria or deteriorating renal function

Question 63

What is the prognosis of membranous nephropathy

Answer 63

Resolves spontaeously in 1/3 Good if treated patients whose proteinuria resolves 25% are on dialysis in 10 years

Question 64

How does reduced oncotic pressure in nephrotic syndrome cause oedema

Answer 64

Hypoalbuminemia reduces the capillary oncotic pressure and the imbalance of Starling’s forces leads to interstitial leakage of fluid and decreased circulating volume. The under-fill theory proposes that the decreased circulating volume leads to renal hypoperfusion and activation of the renin-angiotensin-aldosterone system (RAAS) Stimulation causes avid sodium and water reabsorption

Question 65

Why do you get excessive sodium retention in nephrotic syndrome

Answer 65

Excessive sodium retention occurs in some individuals with nephrotic syndrome in the absence of activation of the renin-angiotensin-aldosterone system, suggesting an intrinsic defect in sodium excretion by the kidney.