Glomerulonephritis Overview

Question 1

What is glomerulonephritis?

Answer 1

Inflammation of the glomerulus

Question 2

What is often required for a diagnosis of glomerulonephritis?

Answer 2

Kidney biopsy

Question 3

Which type of vessels make up the glomerulus?

Answer 3

Capillaries

Question 4

What are the three layers of the triple filtration barrier of the glomerulus?

Answer 4

Endothelium cells on the inner side
Glomerular basement membrane in the middle
Podocytes on outer side

Question 5

What is meant by active urine sediment?

Answer 5

If you look at a urine sample under the microscope, there would be haematuria, dysmorphic RBC’s and cellular casts seen

Question 6

What are the three features of nephritic state?

Answer 6

Active urine sediment
Hypertension
Renal impairment

Question 7

What are the four features of nephritic syndrome?

Answer 7

Oedema
Nephrotic range of proteinuria (>3.5g/day pr 350mg/mmol of creatinine)
Hypoalbuminemia (serum albumin <35g/L)
Dyslipidaemia

Question 8

What happens in nephritic state?

Answer 8

Invasion of the glomerulus by inflammatory cells
Attacks endothelium and damages glomerular basement membrane and podocytes
Disruption of these filter layers means leak of blood cells

Question 9

What happens in nephrotic state?

Answer 9

Thickening of glomerular basemen membrane
Shrinking of podocytes meaning the foot processes come apart leading to the spillage of albumin

Question 10

Glomerulonephritis can be classified as proliferative or non-proliferative.
When is glomerulonephritis known to be proliferative?

Answer 10

When there is excessive number of cells in the glomeruli, including infiltrating leucocytes

Question 11

Glomerulonephritis can be classified as proliferative or non-proliferative.
When is glomerulonephritis known to be non-proliferative?

Answer 11

Glomeruli look normal or have areas or scarring but a normal number of cells

Question 12

Which techniques can be used to asses glomerulonephritis ?

Answer 12

Immunofluorescence or electron microscopy

Question 13

In terms of pathology description, what is meant if it is said there is diffuse glomerulonephritis ?

Answer 13

> 50% of the glomeruli are affected

Question 14

In terms of pathology description, what is meant if it is said there is focal glomerulonephritis ?

Answer 14

<50% of the glomeruli are affected

Question 15

In terms of pathology description, what is meant if it is said there is global glomerulonephritis ?

Answer 15

All the glomerulus is affected

->global = whole world

Question 16

In terms of pathology description, what is meant if it is said there is segmental glomerulonephritis ?

Answer 16

Only part of the glomerulus is affected

Question 17

Okay, what is the difference between nephrotic syndrome and nephritic syndrome?

Answer 17

Nephrotic- loss of significant volumes of protein, resulting in hypoalbuminemia

Nephritic- involves haematuria, mild to moderate proteinuria, hypertension.

Question 18

What is the commonest cause of glomerulonephritis ?

Answer 18

IgA nephropathy

Question 19

What is IgA nephropathy characterised by?

Answer 19

Deposition of IgA in the mesagium
Mesangial proliferation

Question 20

In which decades of life is IgA nephropathy more common?

Answer 20

2nd and 3rd decades of life

Question 21

What are the different way that IgA nephropathy can present?

Answer 21

-Microscopic haematuria
-Microscopic haematuria and proteinuria
-Nephrotic syndrome
-IgA crescentic glomerulonephritis

Question 22

What is the best way to deal with end stage kidney disease?

Answer 22

Kidney transplant

Question 23

Post-infectious glomerulonephritis ?

Answer 23

Disease of the kidney occurring after an infection of a different part of the body

Question 24

When does post-streptococcal glomerulonephritis occur?

Answer 24

Follows 10-21 days after infection of typically throat or skin

Question 25

What type of streptococcus is post-streptococcal glomerulonephritis most commonly associated with?

Answer 25

Lancefield group A Streptococci

Question 26

How is post infectious glomerulonephritis treated?

Answer 26

Antibiotics for infection in some cases Loop diuretics e.g. frusemide for oedema Anti-hypertensive drugs

Question 27

What is the most severe form of proliferative glomerulonephritis ?

Answer 27

Crescentic glomerulonephritis

Question 28

What is the commonest type of crescentic glomerulonephritis?

Answer 28

ANCA associated glomerulonephritis ->recap- ANCA = anti-neutrophil cytoplasmic antibodies

Question 29

So- crescentic glomerulonephritis is bad and ANCA associated crescentic glomerulonephritis is the most common. There are three types of ANCA associated crescentic glomerulonephritis. Name them

Answer 29

Microscopic polyangiitis Granulomatosis with polyangiitis Eosinophilic granulomatosis with polyangiitis

Question 30

Okay got told this in clinical skills today! What is the triad for nephrotic syndrome?

Answer 30

The three O's apparently :) Oedema HypOalbuminemia PrOteinuria

Question 31

Does proliferative glomerulonephritis usually present with a nephritic or nephrotic state?

Answer 31

Nephritic

Question 32

Name the three non-proliferative glomerulonephritis conditions.

Answer 32

Minimal Change Disease Focal and segmental glomerulonephritis Membranous Nephropathy

Question 33

What are the general measures taken in any kind of nephrotic syndrome based condition?

Answer 33

Treat oedema- salt and fluid restriction and loop diuretics Hypertension management Reduce risks of thrombosis using heparin or warfarin Reduce risk of infection e.g. pneumococcal vaccine Treat dyslipidaemia using statins ->after these measures have been taken, there can be specific therapy towards the non-proliferative glomerulonephritis

Question 34

Does minimal change disease present with nephritic or nephrotic state?

Answer 34

Nephrotic state

Question 35

Which type of nephrotic state is most common in children?

Answer 35

MCD Minimal Chnage Disease ->mentioned in urinary comms if that rings any bells?

Question 36

How does MCD treated?

Answer 36

Steroids e.g. prednisolone

Question 37

MCD can relapse. What proportion of patients get a relaspe?

Answer 37

2/3

Question 38

What can subsequent relapses of MCD be treated with?

Answer 38

Cyclophosphamide Cyclosporine Tacrolimus

Question 39

Does MCD have a high chance of progressing into end stage renal disease?

Answer 39

No prognosis is good

Question 40

Does focal and segmental glomerulonephritis present with neprhitic or nephrotic syndrome?

Answer 40

Nephrotic syndrome

Question 41

How is focal and segmnetal glomerulonephritis treated?

Answer 41

General measures for nephrotic syndrome e.g. diuretics, hypertension control etc. Trial of steroids but generally steroid resitsant ut good to try If steroids don't work = cyclosporine, cyclophosphamide, rituximab

Question 42

What is the commonest cause of nephrotic state in adults?

Answer 42

Membranous nephropathy

Question 43

The majority of membranous nephropathy cases occur in isolation but what can be some secondary causes?

Answer 43

Malignancies Rheumatoid arthritis NSAIDs, gold, penicillamine

Question 44

What is the treatment of membranous nephropathy?

Answer 44

General measures for nephrotic syndrome for at least six months Cyclophosphamide and steroids, alternative months for 6 months Tacrolimus Rituximab