Glomerulonephritis

Question 1

What 3 layers compose the filtration barrier at the glomerulus?

Answer 1

Endothelial lining (fenestrated)
Basal lamina
Podocytes

Question 2

What is the glomerulus?

Answer 2

A ball of looped capillaries

Question 3

Through which vessels does blood enter the glomerulus?

Answer 3

Afferent arteriole

Question 4

Through which vessels does blood exit the glomerulus?

Answer 4

Efferent arteriole

Question 5

What type of molecules are not filtered out the blood?

Answer 5

Proteins (equal or bigger than albumin)

RBC

Question 6

What cells are responsible for supporting the glomerulus?

Answer 6

Mesangial cells

Question 7

Where does filtrate go after leaving the glomerulus?

Answer 7

Bowman’s space

Question 8

What is the pathology of glomerulonephritis?

Answer 8

Disease of glomerulus, can be inflammatory or non-inflammatory

Question 9

What are the 4 most common presentations of glomerulonephritis?

Answer 9

Haematuria
Heavy proteinuria (nephrotic syndrome)
Slowly increasing proteinuria
Acute renal failure (AKI)

Question 10

What are the main causes of haematuria?

Answer 10

UTI
Urinary tract stone
Urinary tract tumour
Glomerulonephritis

Question 11

What types of haematuria can occur?

Answer 11

Macroscopic - discoloured urine

Microscopic (2)

Question 12

What tests would you do in someone presenting with discoloured urine?

Answer 12

Dipstick test
MSSU - urine culture
Ultrasound scan
Renal biopsy

Question 13

What pathological findings will be observed in biopsy associated with IgA glomerulonephritis?

Answer 13

IgA (immnoglobulin)

C3 complement

Question 14

What is the cause of IgA glomerulonephritis?

Answer 14

Unknown - antibody excess

Question 15

What disease progress is observed in IgA glomerulonephritis?

Answer 15

Accumulation of IgA at the glomerulus, clogging the filter membrane

Question 16

What happens to the mesangial cells in IgA glomerulonephritis?

Answer 16

Proliferation & matrix expansion

Question 17

What is observed in the urine in IgA glomerulonephritis?

Answer 17

Blood cells

Question 18

What is the prognosis for IgA glomerulonephritis?

Answer 18

Usually self-limiting

Small % develop chronic renal failure

Question 19

If high levels of albumin are present in urine what would this suggest?


Answer 19

Leaky glomeruli filtration barrier

Question 20

If there is heavy protein loss, (>2g/day) what is this suggestive of?

Answer 20

Nephrotic syndrome

Question 21

What investigations would you carry out if suspected nephrotic syndrome?

Answer 21

Renal biopsy

Question 22

In membranous glomerulonephritis, what deposits are found between the pdocytes & BL?

Answer 22

IgG

Question 23

In membranous glomerulonephritis, what does IgG activate? What action does it have?

Answer 23

C3 complement & results in holes being punched in glomerular membrane

Question 24

What is the underlying cause of IgG (membranous glomerulonephritis)?

Answer 24

Unknown

Question 25

If there is a massive loss of plasma protein, would sign will be observed peripherally?

Answer 25

Oedema

Question 26

In a diabetic nephropathy, what causes leakage of albumin out of glomerulus?

Answer 26

Glycated molecules deposit in BL & mesangium resulting in thickened BL & mesangial matrix

Question 27

In diabetic nephropathy, what is another name for nodules of mesangial matrix?

Answer 27

Kimmelsteil-Wilson lesion

Question 28

What hastens poor prognosis in diabetic nephropathy?

Answer 28

Poor glycemic control

Question 29

What tests would you do to test GFR?

Answer 29

Serum creatinine

Question 30

What would rapidly rising creatinine be indicative of?

Answer 30

Acute kidney failure

Question 31

What does US allow you to visualise in renal tract?

Answer 31

Presence/absence of obstruction

Question 32

When the glomerulus is crushed by a crescent of macrophages, what is this called?

Answer 32

Crescenteric glomerulonephritis

Question 33

What causes crescentic gloermulonephritis?

Answer 33

Wegners granulomatosis

Question 34

What is another name for Wegners granulomatosis?

Answer 34

Granulomatosis with polyangiitis

Question 35

What is Granulomatosis with polyangiitis?

Answer 35

A form of vasculitis which affects the vessels of kidneys, nose & lungs

Question 36

What tests could you perform to test for Wegners granulomatosis?

Answer 36

serum ANCA test (anti-neutrophil cytoplasmic antibodies)

Question 37

What are ANCA antibodies directed against?

Answer 37

Enzymes in primary granules of neutrophils

Question 38

What can be used to treat Wegeners?

Answer 38

Cyclophosphamide

Question 39

What are the 4 different types of glomerulonephritis?

Answer 39

IgA glomerulonephritis Membranous glomerulonephritis Diabetic nephropathy Crescentic glomerulonephritis