Glomerulonephritis

Question 1

How is glomerulonephritis classified?

Answer 1

Nephritic syndrome

Question 2

Sxs of glomerulonephritis

Answer 2

Hematuria, proteinuria, HTN, decreased GFR, +/- edema

Question 3

What age/sex group is glm. most prevalent in?

Answer 3

males 3-7 years old

Question 4

What percentage of pats recover without sequelea

Answer 4

95% children and 70% adults

Question 5

Acute asymptomatic glomerular hematuria

subsets

Answer 5

Post-infectious glomerulonephritis & IgA nephropathies

Occur after acute infection

Question 6

Post-infectious glmn. most prevalent in?

Answer 6

Children

Question 7

What infectious agent causes Post-infectious Glomerulonephritis?

Answer 7

Group A strep
S. aureus
Secondary to strept throat, impetigo, bacteremia

Question 8

What are the sxs of Post-infectious Glomerulonephritis?

Answer 8

+/- Proteinuria, gross hematuria, HTN, oliguria, low serum complement levels

Question 9

What test is needed to diagnose post-infectious glmn?

Answer 9

Elevated ASO titer: Anti-streptolysin need to make diagnosis

Question 10

IgA Neuropathy definition

Answer 10

Systemic IgA vasculitis

Question 11

What is the most common glmn. worldwide?

Answer 11

IgA Neuropathy

Question 12

What are the subsets of IgA neuropathy?

Answer 12

Berger disease

Henoch Schonlein Purpura

Question 13

What are the sxs and etiology of berger disease? How is it diagnosed?

Answer 13

1. Berger Disease: in males-late teens to 30’s (Acute or Chronic)
2. Follows viral (usually) URI symptoms (1-2 days)
3. Gross hematuria, edema (hands & feet)
4. ESRD develops in 20-30% of cases
5. Clinical diagnosis

Question 14

Where does Henoch Schonlein purpura usually occur?

Answer 14

Small vessel vasculitis usually on trunk and legs, not arms or face

Question 15

What infectious agents usually cause Henoch Schonlein purpura?

Answer 15

Follows Group A strep or viral inf.

Question 16

What are the sxs for Henoch Schonlein purpura?

Answer 16

Vasculitis rash (palpable purpura), arthralgias, +/- melena, +/- abd pain

Question 17

What are the ds for Henoch Schonlein purpura?

Answer 17

↓ GFR Check blood work, basic metabolic panel

Question 18

What is granulomatosis w/ polyangiitis classified as?

Answer 18

Rapidly Progressive Glomerulonephritis (RPGN)

Question 19

what is another name for granulomatosis w/ polyangiitis?

Answer 19

“Pauci-immune” necrotizing glomerulonephritis

Wegener’s disease

Question 20

What is the pathophysiology of granulomatosis w/ polyangiitis?

Answer 20

Circulating ANCA antibodies

Bind to cytoplasmic Ag on neutrophil surfaces

Question 21

Sxs of granulomatosis w/ polyangiitis?

Answer 21

Glomerulonephritis → ESRD , pulmonary nodules that may bleed (can have nosebleeds), arthritis, neuropathy, purpura, hematuria, proteinuria, upper or lower resp bleed (hemoptysis)

Question 22

What is goodpasture syndrome classified as?

Answer 22

Rapidly Progressive Glomerulonephritis (RPGN)

Question 23

Goodpasture syndrome pathophys

Answer 23

Autoimmune disease - immune system attacks kidney and lung tissue
Characterized by glomerulonephritis &/or bleeding of lungs

Question 24

Risk factors for goodpasture disease

Answer 24

M > F in early years
2nd-3rd decades OR 6th-7th decades
Lungs affected by smoking, hydrocarbon solvent exposure

Question 25

What is Systemic Complex glomerulonephritis classified as?

Answer 25

Immune Complex Glomerulonephritis

Question 26

What renal diseases are seen with SLE?

Answer 26

Glomerulonephritis Tubulointerstitial nephritis Vasculitis

Question 27

What is the diagnostic test for SLE?

Answer 27

Kidney bx

Question 28

What disorders are included in Nephrotic Spectrum Glomerular Diseases?

Answer 28

``` Membranoproliferative glomerulonephritis Membranous nephropathy Focal granulosclerosis Rapidly progressive glomerulonephritis Post streptococcal glomerulonephritis Hemolytic uremic syndrome (HUS) ```

Question 29

Sxs of Nephrotic Spectrum Glomerular Diseases?

Answer 29

1. Bland urine sediment ( few/no cells or casts) 2. Urine protein excretion > 3 g/24 hr 3. Albumin < 3 g/dL 4. Peripheral edema 5. Hyperlipidemia 6. Oval fat bodies in urine

Question 30

Pathophysiology of Glomerulonephritis

Answer 30

1. Activation of coagulation system leads to fibrin deposits in Bowman’s capsule 2. End result is crescent shaped blood cells and decreased blood flow and GFR Crescents signify SEVERE AND IRREVERSIBLE kidney damage 3. Glomerular bleeding acidifies urine Transforms hemoglobin to methemoglobin Brown urine

Question 31

What is the most common cause of Nephrotic Glomerular Dz in the US?

Answer 31

DM

Question 32

What are 4 causes of Nephrotic Glomerular Dz?

Answer 32

DM (most common in US) Amyloidosis Focal segmental glomerulosclerosis Membranoproliferative Glomerulonephritis

Question 33

What are 3 complications of glomerulonephritis?

Answer 33

1. End Stage Renal Failure 2. Cardiac hypertrophy: bc heart is trying to work harder due to hypervolemia 3. Heart failure

Question 34

Glomerulonephritis sxs

Answer 34

``` Periorbital & peripheral edema Mild to severe HTN Dyspnea, orthopnea, bibasilar rales Decreased urination Brown colored urine: methemoglobin ```

Question 35

DS results for glomerulonephritis

Answer 35

1. Increased BUN & Creatinine 2. Decreased serum protein: due to filtration problems and reabsorption problems 3. Decreased hemoglobin 4. Elevated anti-streptolysin O titers in 80% patients (post-infectious) 5. Low serum complement levels Proteins in plasma that combine with antibodies causing destruction of antigens

Question 36

Urinalysis results for glomerulonephritis

Answer 36

RBC’s, WBC’s, mixed cell casts, protein

Question 37

When is a throat culture performed?

Answer 37

on pts with history of infection and sore throat

Question 38

For pts with DM, how often is a urine microalbumin test performed?

Answer 38

Annually or more frequently

Question 39

When is a renal biopsy indicated in glomerulonephritis?

Answer 39

If >50% of glomeruli contain crescents  rapidly progressive glomerulonephritis

Question 40

Tx for acute or progressive glomerulonephritis

Answer 40

Antibiotics for post-infectious type Fluid restriction and dietary Na+ restriction Bed rest: decrease demand on heart Loop diuretics for ECF overload ACE inhibitor or ARB for HTN Corticosteroids suppress inflammatory response in immune complex GN Immunosuppressive therapy (CellCept, Tacrolimus) Plasmapheresis Interferon-alpha for Hep C GN Statins for hyperlipidemia: monitor for rhabdo

Question 41

Tx of chronic glomerulonephritis

Answer 41

Treat primary disease for chronic glomerulonephritis | Dialysis or kidney transplant