Glomerulonephritis

Question 1

True or false: A patient with blood and protein in their urine will always have glomerulonephritis?

Answer 1

False

Question 2

When a urine dipstick is positive what is the first test you need to do?

1. Send urine for ACR
2. Send urine for culture and sensitivity
3. send urine for PCR

Answer 2

2. Send urine for culture and sensitivity

Question 3

If a patient has an urinary tract infection, what are the parameters which may be positive? (All that apply)

1. Blood and proteins
2. Nitrites
3. Leucocytes

Answer 3

1 +2+3

Blood, protein, nitrites, leucocytes

Question 4

If the patient urine dipstick is positive for invisible haematuria, which department would you refer the patient to?

1. Urology
2. Nephrology
3. Haematology

Answer 4

1 +2
Urology- might have cancer
Nephrology - Might have GN
Haematology is only involved in cases where there is a bleeding or coagulation problem. In that case the patient would be bleeding from more than one site.

Question 5

True or False: USS kidneys are done to find out the type of glomerulonephritis?

Answer 5

False

Question 6

True or False: USS kidneys are done to rule out urinary tract obstructions?

Answer 6

True

Question 7

RBC’s when examined under the microscope can more commonly be dysmorphic if the RBC’s are leaking from the glomeruli rather than leaking from a bleeding vessel from the ureters, bladder, urethra.

Answer 7

True

Because the biconcave shaped RBC gets squashed and loses their shape as they pass through the glomerular capillaries.

Question 8

What is the normal urine protein excretion in a day?

1. 3g/24hrs
2. 300mg/24hrs
3. <150mg/24hrs

Answer 8

3. <150mg/24hrs

Question 9

True or False: Nephrotic range proteinuria is >3.5g/24hrs

Answer 9

True

Question 10

True or False: Nephrotic range proteinuria is very common in UTI’s

Answer 10

False

Question 11

True or False:

Nephrotic range proteinuria is very common in bladder cancer

Answer 11

False

Question 12

True or False:

Nephrotic range proteinuria is seen in glomerulonephritis

Answer 12

True

Question 13

Tolvaptan is a new drug approved by NICE for use in certain patients with ADPKD. The precautions needed to use this drug are:

1. Annual MRI volume measurement of the kidney is required
2. The eGFR needs to be less than 30ml/min
   3, Patient needs to drink plenty of fluids
3. Patients need regular blood tests including renal and liver function tests

Answer 13

1 + 3 + 4

Question 14

What is glomerulonephritis and what are the consequences?

Answer 14

Glomerulonephritis simply means inflammation of the glomeruli and nephrons.

The consequences of this inflammation are:
• Damage to the glomerulus restricts blood flow, leading to compensatory hypertension
• Damage to the filtration mechanism allows protein and blood to enter the urine
• Loss of the usual filtration capacity leads to acute kidney injury

Question 15

How can glomerulonephritis present?

Answer 15

Depending on the degree of inflammation and damage, and what it is caused by, patients therefore present with a spectrum of disease:

1. Blood pressure: normal –> malignant hypertension
2. Urine dipstick: proteinuria mild –> nephrotic, haematuria mild –> macroscopic
3. Renal function: normal –> severe impairment

Question 16

Many GN patients present with specific syndromes. What is the BP, urine and GFR like for nephrotic syndrome?

Answer 16

BP: Normal to Mild ↑
Urine: Proteinuria
GFR: Normal to mild ↓

Question 17

What are the primary and secondary causes of nephrotic syndrome?

Answer 17

Common Primary causes

• -> Membranous
• -> Minimal change
• -> FSGS
• -> Mesangiocapillary GN

Common secondary causes:

• -> Diabetes
• -> SLE
• -> Amyloid
• -> Hepatitiis B/C

Question 18

Many GN present with specific syndromes. What is the BP, urine and GFR like for nephritic syndrome?

Answer 18

BP: Moderate to severe ↑
Urine: Haematuria
GFR: Moderate to severe ↓

Question 19

What are the primary and secondary causes of nephritic syndrome?

Answer 19

Common primary causes:

• -> IgA nephropathy
• -> Mesangiocapillary GN

Common secondary causes:

• -> Post-Streptococcal
• -> Vasculitis
• -> SLE
• -> Anti-GBM disease
• -> Cryoglobulinaemia