Glomerulonephritis (GN)

Question 1

define GN

Answer 1

immune-mediated disease of the kidneys affecting the glomerular capillary wall

Question 2

how do endothelial cells respond to injury?

Answer 2

vasculitis

haematuria

Question 3

how do podocytes respond to injury?

Answer 3

atrophies increase gap size of the barrier

proteinuria

Question 4

how does the mesangium respond to injury?

Answer 4

proliferation and chemokines

haematuria

Question 5

presentation of GN

Answer 5

haematuria
proteinuria
nephrotic/nephritic syndrome
hypertension

Question 6

classification of proteinuria

Answer 6

Microalbuminuria (30-300mg albuminuria/day)
Asymptomatic proteinuria (<1g/day)
Heavy proteinuria (1-3g/day)
Nephrotic syndrome (>3g/day)

Question 7

diagnosis of GN

Answer 7

urinarlysis (haematuria, proteinuria, granular casts, RBCs, lipiduria)
bloods
kidney biopsy (LM, IF, EM)

Question 8

non-immunosuppressant management options of GN

Answer 8

anti-hypertension (<130/80, <120/75 if proteinuria)
ACEI/ARB
diuretics
statins
anticoagulants
antiplatelets
fish oil

Question 9

immunosuppressant management options for GN

Answer 9

corticosteroids 
azathioprine
alkylating agents (cyclophosphamide)
calcineurin inhibitors (cyclosporin)
plasmapheresis (TPE)
antibodies

Question 10

what are granular casts?

Answer 10

precipitation of Tamm-Horsfall mucoprotein in low pH

Question 11

types of casts

Answer 11

hyaline (benign)
red cells (pathological)
leucocytes (infection/inflammation)
granular (chronic disease)

Question 12

what does the presence of RBC casts in urine prove?

Answer 12

haematuria is glomerular

Question 13

two classes of GN

Answer 13

primary

secondary

Question 14

examples of secondary causes of GN

Answer 14

infection
drugs
systemic-ANCA, SLE, GP, HSP

Question 15

what are the five types of idiopathic/ primary GN?

Answer 15

1. minimal change
2. focal segmental glomerulosclerosis (FSGS)
3. membranous nephropathy
4. IgA nephropathy
5. membranoproliferative

Question 16

who does minimal change present in?

Answer 16

children

Question 17

presentation of minimal change GN

Answer 17

facial/ generalised oedema

nephrotic proteinuria

Question 18

diagnosis of minimal change GN

Answer 18

normal renal biopsy with slight gaps between podocytes

Question 19

management of minimal change GN

Answer 19

complete remission with steroids

Question 20

causes of FSGS

Answer 20

obesity
HIV
sickle cell
IV drug users

Question 21

what is the commonest cause of nephrotic syndrome in adults?

Answer 21

FSGS

Question 22

diagnosis of FSGS

Answer 22

renal biopsy LM shows minimal Ig/complement deposition with podocyte fusion/sclerosis

Question 23

management of FSGS

Answer 23

some have remission on steroids

can progress to ESRF

Question 24

two types of membranous nephropathy

Answer 24

1. primary

2. secondary

Question 25

secondary causes of membranous nephropathy

Answer 25

``` HepB parasites SLE carcinoma of lung, colon melanoma lymphoma syphilis NSAIDs captopril gold penicillamine ```

Question 26

diagnosis of membranous nephropathy

Answer 26

immune complex deposition (anti-PLA2r Ab and C3) in BM with thickened membrane on silver stain (spiky)

Question 27

management of membranous nephropathy

Answer 27

steroids alkylating agents B cell monoclonal Ab

Question 28

what can membranous nephropathy progress to?

Answer 28

ESRF

Question 29

which is the commonest type of GN?

Answer 29

IgA nephropathy

Question 30

presentation of IgA nephropathy

Answer 30

``` non-nephrotic proteinuria haematuria following resp/GI infection AKI/CKD Coeliac's HSP ```

Question 31

diagnosis fo IgA nephropathy

Answer 31

biopsy shows mesangial cell proliferation | LM IgA deposits in mesangium

Question 32

management of IgA nephropathy

Answer 32

BP control ACEI/ARB fish oil

Question 33

what can IgA nephropathy progress to?

Answer 33

ESRF

Question 34

causes of membranoproliferative GN

Answer 34

hep C SLE malignancy

Question 35

who gets membranoproliferative GN?

Answer 35

adults and children

Question 36

presentation of membranoproliferative GN

Answer 36

nephritic | nephrotic

Question 37

diagnosis of membranoproliferative GN

Answer 37

thick membranes- tram tracks

Question 38

what is rapidly progressive GN (RPGN)?

Answer 38

rapid deterioration of renal function over days/weeks

Question 39

diagnosis of RPGN

Answer 39

active urinary sediment (RBCs, granular casts) | glomerular crescents on biopsy

Question 40

causes of RPGN

Answer 40

any GN | ANCA +ve and -ve

Question 41

management of RPGN

Answer 41

immunosuppression plasmapheresis dialysis if needed

Question 42

presentation of nephritic syndrome

Answer 42

``` renal failure (high K+) oliguria haematuria oedema hypertension ```

Question 43

diagnosis of nephritic syndrome

Answer 43

active urinary sediment (RBCs, granular casts)

Question 44

nephrotic syndrome presentation

Answer 44

proteinuria can have normal renal function facial swelling oedema

Question 45

diagnosis of nephrotic syndrome

Answer 45

proteinuria >3g/day hypoalbuminuria (<30) low complement hypercholesterolaemia

Question 46

complications of nephrotic syndrome

Answer 46

``` infections renal vein thrombosis PE volume depletion (diuretics) vitamin D deficiency hypothyroidism ```

Question 47

management of nephrotic syndrome

Answer 47

``` fluid and salt restriction diuretics ACEI/ARB anticoagulants immunosuppression ```