Glomerulonephritis

Question 2

Define glomerulonephritis.

Answer 2

Inflammation of the glomeruli causing injury, leading to either nephritic (protein <3.5g/day) or nephrotic (>3.5g/day)

Question 3

How is Nephritic Syndrome characterized compared to nephrotic syndrome?

Answer 3

Question 4

What is the difference between segmental and global glomerular involvement?

Answer 4

Segmental: Part of the glomerulus is affected.
Global: The entire glomerulus is affected.

Question 5

What is the difference between crescentic and proliferative glomerulonephritis?

Answer 5

Crescentic: Increased cells in Bowman’s capsule.
Proliferative: Increased cells in the glomerulus.

Question 6

What is the difference between focal and diffuse glomerulonephritis?

Answer 6

Question 7

What are the common cause of glomerular injury?

Answer 7

It is most commonly immune-mediated but can also result from infections or non-inflammatory causes.
E.g. - Strep infections, SLE, DM, Alport’s syndrome, and IgA nephropathy (Berger’s disease).

Question 8

How does glomerular injury affect filtration?

Answer 8

It leads to disruption of the basement membrane, disrupting filtration.

Question 9

How is nephritic syndrome classified based on immunofluorescence findings? (list)

Answer 9

linear
immune complex (granular) - low c3/c4 or normal c3/c4
pauci immune

Question 10

What does a linear immunofluorescence pattern in nephritic syndrome indicate?

Answer 10

Continuous staining along the basement membrane, typically seen in Anti-GBM disease (Goodpasture’s syndrome)

Question 11

What are examples of nephritic diseases with low C3/C4 levels?

Answer 11

Slowly Progressive: Membranoproliferative glomerulonephritis (mesangiocapillary) and Cryoglobulinemic glomerulonephritis.
Rapidly Progressive: SLE nephritis and Post-streptococcal glomerulonephritis

Question 12

What are examples of nephritic diseases with normal C3/C4 levels?

Answer 12

IgA nephropathy (Berger’s disease).
IgA vasculitis (Henoch-Schönlein purpura)

Question 13

What does Pauci-immune nephritic syndrome indicate?

Answer 13

Minimal or no immune complex staining, associated with ANCA-positive diseases

Question 14

What are examples of ANCA-associated conditions in Pauci-immune nephritic syndrome?

Answer 14

Question 15

What are the nephritic symptoms in GN?

Answer 15

Hematuria: Coca-cola colored urine.
Oliguria: Reduced urine output.
Blurred Vision: From hypertension.
Fever: Often from infectious causes

Question 16

What are the nephrotic symptoms in GN?

Answer 16

Frothy urine (proteinuria).
Edema (facial, periorbital, lower limbs).
Weight gain due to fluid retention.
Orthopnea/PND (hydrothorax).
Uremic symptoms like pruritis (uremic frost on skin), and brain encephalopathy (confusion, seizures, asterixis)
REDUCED URINE OUTPUT

Question 17

What are the uremic symptoms in GN?

Answer 17

can be due to other waste products (not only urea)

Question 18

What are 2 common underlying disease which may cause nephrotic/ nephritic syndrome or GN? What are their common clinical features.

Answer 18

Question 19

What are all the symptoms of GN?

Answer 19

Question 20

What are the nephritic signs in GN?

Answer 20

HTN

Question 21

What are the nephrotic signs in GN?

Answer 21

Question 22

What signs of underlying disease would you be looking for in a patient with GN?

Answer 22

Question 23

What type of GN has a mixed nephrotic - nephritic picture or can present as either or?

Answer 23

Question 24

What are all the signs of GN?

Answer 24

Question 25

List some ddx for GN

Answer 25

Question 26

What would you find on urinalysis of GN?

Answer 26

Question 27

How would you investigate for GN?

Answer 27

Question 28

What is the role of dendritic cells and macrophages in the immune system?

Answer 28

Dendritic cells and macrophages detect antigens, acting as antigen-presenting cells (APCs)

Question 29

What do antigen-presenting cells (APCs) do after detecting an antigen?

Answer 29

They present the antigen to CD4+ T cells

Question 30

How do T cells contribute to antibody production?

Answer 30

T cells activate B cells, prompting them to differentiate into plasma cells

Question 31

What are the key functions of antibodies?

Answer 31

Question 32

What is the function of plasma cells in the immune system?

Answer 32

Question 33

What is the main feature of rapidly progressive glomerulonephritis (RPGN)

Answer 33

RPGN is characterized by the proliferation of parietal epithelial cells and macrophages in Bowman’s capsule.

Question 34

What is the effect of Anti-GBM in GN?

Answer 34

Anti-GBM antibodies target Type IV collagen in the glomerular basement membrane, producing a continuous linear pattern on biopsy

Question 35

How is Anti-GBM disease treated?

Answer 35

Question 36

What clinical features are a/w Churg-Strauss Syndrome?

Answer 36

Question 37

Which ANCA subtype is associated with Granulomatosis with Polyangiitis?

Answer 37

Question 38

What ANCA type is associated with Microscopic Polyangiitis?

Answer 38

Question 39

WHat are the antibodies involved in SLE nephritis? What are the other symptoms of SLE?

Answer 39

Question 40

How is Post-Streptococcal Glomerulonephritis (GN) diagnosed?

Answer 40

Question 41

Describe the structure of the large glomeruli.

Answer 41

Question 42

What is the mesangial cells of the glomerulus and what is its function

Answer 42

Question 43

What does biopsy of membranoproliferative GN or mesangiocapillary GN show?

Answer 43

Question 44

What are the RFs for nephrotic membranoproliferative GN.

Answer 44

Question 45

What is the treatment of mesangiocapillary or membranoproliferative GN?

Answer 45

Question 46

What are the types of cryoglobulinemia? How is it diagnosed?

Answer 46

Question 47

Why is C3/C4 normal in IgA nephropathy?

Answer 47

Question 48

How does IgA nephropathy typically present?

Answer 48

Question 49

What does biopsy of IgA nephropathy show? How is it treated?

Answer 49

Question 50

What are common clinical features of IgA vasculitis? How is it treated?

Answer 50

Question 51

What is the pharmacological treatment of slowly progressive GN?

Answer 51

Question 52

What is the pharmacological treatment of rapidly progressive GN?

Answer 52

Question 53

What are the indications for a kidney biopsy in a non-transplanted patient?

Answer 53

Question 54

What are the indications for a kidney biopsy in a transplanted patient?

Answer 54

Question 55

What are the contraindications for a kidney biopsy?

Answer 55

Question 56

What are the complications for a kidney biopsy?

Answer 56