Glomerulonephritis

Question 1

What two main groups can glomerulonephritis be divided into?

Answer 1

Proliferative
Non - proliferative

Question 2

What is non - proliferative glomerulonephritis?

Answer 2

Damage to the podocytes

Question 3

What is proliferative glomerulonephritis?

Answer 3

Damage to endothelial/mesangial cells

Question 4

Examples of non proliferative Gn

Answer 4

Minimal change disease

Focal segmental glomerulosclerosis

Membranous Gn

Question 5

Examples of proliferative Gn

Answer 5

Membranoproliferative Gn

IgA nephropathy

Post-streptococcal Gn

Rapidly progressive Gn (crescentic) — either ANCA +ve or ANCA -ve

Question 6

What are ANCA +ve vasculitic disorders?

Answer 6

Microscopic polyangiitis –
p-ANCA

Wegener’s granulomatosis (GPA) –
c-ANCA

Question 7

Goodpasture’s disease is ANCA +ve. True/false

Answer 7

False. ANCA - ve

Often detected by renal biopsy or blood test for anti-GBM antibodies

Question 8

Most common cause of Gn (aka nephritic disease) in adults

Answer 8

IgA nephropathy

Question 9

Most common cause of nephrotic disease in adults

Answer 9

Focal segmental glomerulosclerosis

Question 10

What skin condition is IgA nephropathy associated with?

Answer 10

HSP (henoch - schonlein purpura)

Question 11

Most common nephrotic syndrome in children

Answer 11

Minimal change disease

Question 12

What are some associated causes of focal segmental glomerulosclerosis?

Answer 12

HIV, heroin use and obesity

Question 13

What is the main difference between post - streptococcal Gn and IgA nephropathy?

Answer 13

IgA nephropathy usually occurs 24-48 hrs after URTI

Post streptococcal Gn usually occurs a few weeks after URTI

Question 14

How is proteinuria quantified?

Answer 14

By calculating the urine protein:creatinine ratio. Measured over 24 hours.

Question 15

Chronic GN is the 2nd most common cause of end-stage renal failure (CKD). What is the most common cause?

Answer 15

Diabetic nephropathy, a microvascular complication of diabetes mellitus.

Question 16

Glomerulonephritis is caused by infection. True/false.

Answer 16

False. It is immune-mediated (autoimmune).

Question 17

2nd most common cause of nephrotic syndrome in adults?

Answer 17

Membranous Glomerulonephritis

Question 18

How is minimal change disease shown on microscopy and how is it treated?

Answer 18

Abnormal Podocytes are seen on electron microscopy. Usually treated with supportive care and prednisolone.

Question 19

Focal segmental glomerulosclerosis presents with nephritic syndrome and is treated with steroid. True/false.

Answer 19

False. Focal segmental glomerulosclerosis presents with nephrotic syndrome and steroids are often ineffective.

Question 20

What is membranous GN characterised by and what is it caused by?

Answer 20

Thickened glomerular basement membrane due to immune complex deposition at the basement membrane and is idiopathic.

Question 21

What antibody is membranous GN associated with?

Answer 21

Anti-PLA2R (present in 70% of cases).

Question 22

What characteristic does rapidly progressive Glomerulonephritis have?

Answer 22

Crescentic - presence of crescents (epithelial cell extracapillary proliferation).

Question 23

List primary and secondary causes of membranoproliferative GN

Answer 23

Primary: immune-mediated

Secondary: SLE and Hep

Question 24

Membranoproliferative GN usually progresses to end stage renal failure. True/false

Answer 24

True

Question 25

Wegeners granulomatosis (GPA) is c-ANCA positive and microscopic polyangiitis is p-ANCA positive. True/false.

Answer 25

True

Question 26

GPA presentation?

Answer 26

Vasculitis Affects lungs, kidneys and other organs. C-ANCA +ve Treat with steroids + cyclophosphamide

Question 27

Microscopic polyangiitis presentation?

Answer 27

Small vessel vasculitis P-ANCA +ve Treat with long term steroids +/- cytotoxic agents

Question 28

Another name for Anti-GBM disease

Answer 28

Goodpasture’s disease

Question 29

Goodpasture’s disease presentation?

Answer 29

Presence of autoimmune Anti-GBM antibody in the blood Glomerulus and lungs are affected Haematuria (blood in urine) and haemoptysis (coughing up blood) Treat with steroids +/- steroid sparing agents

Question 30

What bacteria is involved in post - infectious (post -streptococcal) GN?

Answer 30

Strep pyogenes

Question 31

What is treatment for post -strep GN?

Answer 31

Supportive treatment (diet changes etc) Resolves over 2-4 weeks

Question 32

Main differences between nephrotic and nephritic syndrome.

Answer 32

Nephrotic: Urinary albumin > 3g/day Hypoalbuminaemia Periorbital oedema Appearance of “frothy urine” due to high protein lost in urine. Lipiduria Nephritic syndrome: Haematuria/RBC casts Oliguria (low urinary output of less than 400ml per day) Decreased GFR Proteinuria (nowhere near as much as nephrotic syndrome) Appearance of brownish -red (“coca cola”) urine due to presence of haematuria +RBC casts

Question 33

Types of nephrotic syndrome

Answer 33

Focal segmental glomerulosclerosis Membranous nephropathy Amyloidosis Minimal change disease Diabetic nephropathy

Question 34

Types of nephritic syndrome

Answer 34

Post-streptococcal GN (acute) Alport syndrome IgA Nephropathy Rapidly progressive Glomerulonephritis

Question 35

Types of mixed nephrotic/nephritic syndrome

Answer 35

Membranoproliferative GN Diffuse proliferative GN

Question 36

Nephritic syndrome can also present with oedema. True/false

Answer 36

True, nephritic syndrome can also present with mild oedema. Whereas nephrotic syndrome will result in more apparent oedema. This is due to hypoalbuminaemia and large loss of the albumin protein in the urine.

Question 37

Another name for IgA nephropathy?

Answer 37

Berger disease