Glomerulonephritis

Question 1

Definition of glomerulonephritis

Answer 1

Normally means inflammation of glomeruli
Generally caused by immunologic rxn

Question 2

Major clinical manifestation of glomerular injury

Answer 2

Proteinuria
Hematuria
Decreased GFR
Sodium retention

Question 3

2 main syndromes by which glomerulonephritis present

Answer 3

Nephrotic syndrome
Nephritic syndrome

Question 4

What is nephrotic syndrome

Answer 4

Protein wasting secondary to diffuse glomerular damage with proteinuria >3.5g/day , Hypoalbuminemia and edema

Question 5

What is nephritic syndrome

Answer 5

Set of clinical manifestation with hematuria and at least one the folllowing - oliguria, hypertension, high BUN, decreased GFR

Question 6

Main causes of primary glomerulonephritis ( immune response to something )

Answer 6

Acute glomerulonephritis
Postinfectious glomerunephritis
Post streptococcus glomerulonephritis
Infectious glomerulonephritis
Membranoproliferative glomerulonephritis
Rapidly progressive glomerulonephritis
Idiopathic membranous glomerulonephritis
Immune globulin A IgA nephropathy
Chronic glomerulonephritis
Focal glomerular sclerosis

Question 7

Types of glomerulonephritis

Answer 7

Primary - occur on its own
Secondary - occurs afeter disease like lupus, diabetes, etc

Question 8

Main cause of secondary glomerulonephritis

Answer 8

Good pasture syndrome
Hemolytic uremic syndrome
Polyarteritis
Progressive systemic sclerosis
SLE
Wegeners granulomatosis
Thrombocytopenic purpura
Postpartum renal failures

Question 9

Main area of glomerulus affected when presents with nephrotic syndrome

Answer 9

Podocyte

Question 10

Type of histological classification leading to glomerulonephritis with nephrotic syndrome

Answer 10

Minimal change
Focal segmental glomerulosclerosis
Membranous nephropathy

Question 11

Main cause of nephrotic syndrome

Answer 11

Minimal change disease
Dominant cause of idiopathic nephrotic syndrome in childhood

Question 12

Pathogenesis of minimal change nephropathy

Answer 12

Unknown but might be due to factors causing podocyte injury

Question 13

Risk factors minimal change

Answer 13

Atopy
Drugs NSAIDs
Hematological
Malignancies

Question 14

Histological presentation of minimal change

Answer 14

Fusion of podocytes in electron microscopy

Question 15

Presentation minimal change

Answer 15

Severe nephrotic syndrome

Question 16

Management minimal change

Answer 16

High dose glucocorticoid

Question 17

Population more at risk of focal segmental glomerulosclerosis

Answer 17

West African because carry more apolipoprotein L1 gene variant

Question 18

Histology focal segmental glomerulosclerosis

Answer 18

Segmental scar in some glomeruli so need a lot of sample to see it and not mix it with minimal change
Podocytes foot fusion when primary focal segmental glomerulosclerosis

Question 19

Is there immune deposit in focal segmental glomerulosclerosis

Answer 19

Yes in the focal scars , and are non specific

Question 20

Causes of secondary focal segmental glomerulosclerosis

Answer 20

Healing of previous local injury
HIV infection
Heroin misuse
Morbid obesity
Chronic hypertension

Question 21

Presentation of focal segmental glomerulosclerosis

Answer 21

Primary FSGS presents as idiopathic nephrotic syndrome but less responsive to treatment than minimal change, may progress to renal impairment, can recur after transplantation

Secondary FSGS presents with variable proteinuria and outcome

Question 22

Most common cause of nephrotic syndrome in Caucasian adult

Answer 22

Membranous nephropathy

Question 23

Pathogenesis Membranous nephropathy

Answer 23

Antibodies mostly autoantibodies directed at antigens expressed on podocyte surface including M type phospholipase A2 receptor 1

Question 24

Prognosis of Membranous nephropathy

Answer 24

1/3 recover spontaneously
1/3 remainin nephrotic state
1/3 progressive CKD

Question 25

Dx due to glomerulonephritis leading to mild nephritic syndrome

Answer 25

IgA nephropathy Mesangiocapillary glomerulonephritis

Question 26

Main presentation of patient with mild nephritic syndrome

Answer 26

Non visible hematuria Modest proteinuria Slow progressive course of renal dx

Question 27

Main way of detection of IgA nephropathy

Answer 27

During routine exam

Question 28

Type of immune deposits in IgA nephropathy

Answer 28

Mesangial IgA and C3

Question 29

Variant of IgA nephropathy common in children

Answer 29

Henoch-schonlein purpura

Question 30

What is Henoch-schonlein purpura

Answer 30

systemic vasculitis due to infectious trigger

Question 31

Henoch-schonlein purpura tetras symptom

Answer 31

Petechiae task on buttock and lower leg Abdominal pain Arthralgia Renal dx with visible or non visible haematuria with or without proteinuria

Question 32

Prognosis of Henoch-schonlein purpura

Answer 32

Good with spontaneous resolution

Question 33

Second name of mesangiocapillary glomerulonephritis

Answer 33

membranoproliferative glomerulonephritis

Question 34

Renal biopsy findings in membranoproliferative glomerulonephritis

Answer 34

Increased mesangial cells Thickening of glomerular capillary walls

Question 35

Typical presentation of membranoproliferative glomerulonephritis

Answer 35

Proteinuria Haematuria

Question 36

Two main type of membranoproliferative glomerulonephritis

Answer 36

Immunoglobulin deposition from deposition of circulating immune complexes or planted antigens Complement component deposited

Question 37

Associated risk factor to immunoglobulin type of membranoproliferative glomerulonephritis

Answer 37

Infection Autoimmunity Monoclonal gammopathies

Question 38

Associated risk factors in complement type of membranoproliferative glomerulonephritis

Answer 38

Complement gene mutation C3 nephritic factor Partial lipodystrophy

Question 39

Diseases leading to rapidly progressive glomerulonephritis

Answer 39

Focal necrotising glomerulonephritis Diffuse proliferative glomerulonephritis Anti glomerular basement membrane dx

Question 40

Characteristics of rapidly progressive glomerulonephritis

Answer 40

Rapid loss o renal function over days to weeks Hypertension Oedema Non visible haematuria Proteinuria