Glomerulonephritis

Question 1

common causes of glomerular disease (4)

Answer 1

diabetic nephropathy, glomerulonephritis, amyloid nephropathy, transplant glomerulonephropathy

Question 2

commonest cause of renal failure in adults

Answer 2

diabetic nephropathy

Question 3

second commonest cause of renal failure in adults

Answer 3

chronic glomerulonephritis

Question 4

Pathogenesis behind glomerulonephritis

Answer 4

immune mediated disease of the kidneys affecting the glomeruli with tubulointerstitial damage - usually driven by antibodies

Question 5

3 different patterns of injury in glomerulonephritis

Answer 5

Mesangial cells, endothelial cells, podocytes

Question 6

Proliferative injury in glomerulonephritis (2)

Answer 6

endothelial or mesangial cells

Question 7

how do mesangial cells cause proliferative damage in the kidney?

Answer 7

release Ang II, vasoconstric, cause chemokines and inflammatory cells

Question 8

How do endothelial cells cause proliferative damage in the kidneys?

Answer 8

cause a vasculitis which causes rapid damage to the kidney

Question 9

How does damage to podocytes cause kidney damage?

Answer 9

podocytes atrophy causing loss of the barrier and thus protein but no blood will leak

Question 10

Nephrotic syndrome is a triad of…

Answer 10

hypoalbuminaemia, proteinuria, oedema

Question 11

Presentation of nephrotic syndrome may be…

Answer 11

mild increase in BP, normal to mild decrease in GFR

Question 12

Nephritic syndrome tends to have…

Answer 12

proteinuria, haematuria (micro/frank) and potentially hypoalbuminaemia

Question 13

Presentation of nephritic syndrome may be…

Answer 13

mod-severe increased in BP, mod-severe decrease in GFR

Question 14

How does glomerulonephritis lead to increased BP?

Answer 14

damage to glomerulus restricts blood flow, leading to compensatory BP increase to try and restore flow

Question 15

How does glomerulonephrities lead to protein and blood in the urine?

Answer 15

damage to podocytes leads to protein and blood leaking into urine

Question 16

Glomerulonephritis likely to cause nephrotic syndrome

Answer 16

Membranous, minimal change, FSGS, mesangiocapillary

Question 17

Secondary causes of nephrotic syndrome

Answer 17

diabetes, SLE, amyloid, Hep B/C

Question 18

Glomerulonephritis likely to cause nephritic syndrome

Answer 18

IgA nephropathy, Mesangiocapillary

Question 19

Secondary causes of neprhitic syndrome

Answer 19

Post-streptococcal, vasculitis, Anti-GBM

Question 20

Blood tests to do to assess glomerulonephritis

Answer 20

FBC, U&Es, LFTs, ESR, CRP, Ig, Complement, autoantibodies

Question 21

What autoantibodies should be tested for in glomerulonephritis?

Answer 21

ANCA, Anti-GBM, dsDNA, ANA, HBsAg

Question 22

What tests (general) should be done to assess glomerulonephritis?

Answer 22

Blood tests, urine, imaging, ?Renal biopsy

Question 23

What imaging should be done to assess glomerulonephritis?

Answer 23

CXR

Renal USS

Question 24

Why are ACEi and ARBs useful in management of glomerulonephritis?

Answer 24

decreased proteinuria, decrease BP

Question 25

Commonest glomerulonephritis in developed world

Answer 25

IgA nephropathy

Question 26

How does IgA nephropathy normally present?

Answer 26

haematuria (micro/frank)

Question 27

Typical patient for IgA nephropathy

Answer 27

young man with episodic haematuria but well between attacks

Question 28

Features of Henoch Schonlein Purpura

Answer 28

purpuric rash on extensor surfaces, flitting polyarthritis, abdo pain, nephritis

Question 29

What is Henoch Schonlein Purpura?

Answer 29

A systemic variant of IgA nephropathy causing a small vessel vasculitis

Question 30

Anti-GBM autoantibodies are specifically against?

Answer 30

Type IV collagen

Question 31

Where is Type IV collagen found?

Answer 31

in the basement membranes of the lung and kidney - causes pulmonary haemorrhage in smokers

Question 32

Treatment of Anti-GBM glomerulonephritis

Answer 32

plasma exchange + steroids +/- cytotoxics

Question 33

What is post-streptococcal glomerulonephritis?

Answer 33

diffuse, proliferative GN occuring 1-12 weeks after a sore throat of skin infection

Question 34

Tests for post-streptococcal glomerulonephritis?

Answer 34

Anti-streptolysin O and decreased C3

Question 35

Biopsy findings in rapidly progressive GN

Answer 35

all have crescents affecting the glomeruli

Question 36

3 categories of rapidly progressive GN

Answer 36

immune complex disease (45%), ANCA +ve disease (50%), anti-GBM (5%)

Question 37

How does rapidly progressive GN present?

Answer 37

AKI +/- systemic features - pulmonary haemorrhage is the commonest cause of death in ANCA +ve patients

Question 38

Treatment for rapidly progressive GN

Answer 38

immunosuppression, steroids, plasma exchange and cyclophosphamide