L3: Glomerulonephritis - Intro

Question 1

Def of Glomerulonephritis

Answer 1

Glomerular injury and/or inflammation (mainly immune mediated).

Question 2

Terminology of Glomerulonephritis

Answer 2

Question 3

Terminology of Glomerulonephritis

• Primary Vs Secondary

Answer 3

Primary: Kidney disease specifically affecting the glomeruli

Secondary: The glomeruli are affected in the context of a systemic disease (e.g., SLE)

Question 4

Terminology of Glomerulonephritis

• Diffuse Vs Focal

Answer 4

DIFFUSE ▪ > 50% of glomeruli affected
FOCAL ▪ < 50% of glomeruli affected

Question 5

Terminology of Glomerulonephritis

• Global Vs Segmental

Answer 5

GLOBAL ▪ Entire glomerulus is affected

SEGMENTAL ▪ Only part of the glomerulus is affected

Question 6

Terminology of Glomerulonephritis

• Sclerosing Vs Necrotizing

Answer 6

SCLEROSING ▪ Scaring of the glomerulus

NECROTIZING ▪ Tissue damage/death within the glomerulus

Question 7

Terminology of Glomerulonephritis

• Proleferative Vs Membranous Vs Cresentric

Answer 7

• PROLIFERATIVE
  ▪ Increased proliferation of glomerular cells
• MEMBRANOUS
  ▪ Thickening of the glomerular basement membrane
• CRESCENTIC
  ▪ Crescentic shaped accumulation of cells in the bowman’s space denoting severe inflammation and damage.

Question 8

Etiology of Glomerulonephritis

Answer 8

• Primary
• Secondary

Question 9

Etiology of Glomerulonephritis

• Primary

Answer 9

① Idiopathic

② Hereditary (e.g., Alport’s syndrome - Fabry’s disease - Thin BM disease).

Question 10

Etiology of Glomerulonephritis

• Secondary

Answer 10

Question 11

Secondary Causes of Glomerulonephritis

Answer 11

Question 12

Secondary Causes of Glomerulonephritis

• Infections

Answer 12

Bacteria:
▪ PSGN
▪ Endocarditis

Viruses:
▪ HCV
▪ HBV
▪ HIV

Question 13

Secondary Causes of Glomerulonephritis

• Immune

Answer 13

◈ SLE
◈ ANCA vasculitis
◈ GPS
◈ HSP

Question 14

Secondary Causes of Glomerulonephritis

• Metabolic

Answer 14

DM

Question 15

Secondary Causes of Glomerulonephritis

• Malignancy

Answer 15

◈ Lymphoma
◈ Multiple myeloma

Question 16

Secondary Causes of Glomerulonephritis

• Drus / Toxins

Answer 16

◈ NSAIDs
◈ Heroin

Question 17

Secondary Causes of Glomerulonephritis

• Thrombotic Microangiopathy

Answer 17

◈ HUS
◈ TTP

Question 18

Pathophysiology of Glomerulonephritis

Answer 18

Question 19

Pathophysiology of Glomerulonephritis

• Compostition of Filtration Barrier

Answer 19

Question 20

Compostition of Filtration Barrier

• Capillary endothelium

Answer 20

• Fenestrated glomerular capillary endothelium prevents large proteins from passing through.

Question 21

Compostition of Filtration Barrier

• GBM

Answer 21

• Glomerular Basement Membrane contains a negative charge produced by heparan sulfate.

Question 22

Compostition of Filtration Barrier

• Visceral Epithelial Cells

Answer 22

• Produce/maintain the GBM and contain intercellular junctions created by podocytes that prevent further protein loss.

Question 23

Damage to the glomeruli → …..

Answer 23

• disruption of the glomerular filtration barrier → can lead to nephritic or nephrotic syndrome.

Question 24

CP of Glomerular Diseases

Answer 24

① Asymptomatic
② Macroscopic hematuria
③ Nephrotic syndrome
④ Nephritic syndrome
⑤ Rapidly progressive glomerulonephritis
⑥ Chronic glomerulonephritis

Question 25

Pathology of **Glomerular Diseases**

Answer 25

Question 26

Underlying Pathology in Nephrotic Syndrome

Answer 26

① Minimal change disease ② Focal segmental glomerulosclerosis ③ Membranous nephropathy

Question 27

Underlying Pathology in Nephritic Syndrome

Answer 27

① Mesangio-proliferative GN ② Diffuse proliferative GN

Question 28

Underlying Pathology in Nephritic OR Nephritic syndrome

Answer 28

Membranoproliferative glomerulonephritis **MPGN**

Question 29

Epidemeology of **Minimal Change Disease**

Answer 29

MCD is the most common cause of nephrotic syndrome in children.

Question 30

Etiology of **Minimal Change Disease**

Answer 30

Question 31

Pathology in **Minimal Change Disease**

Answer 31

Question 32

Presentation of **Minimal Change Disease**

Answer 32

Usually nephrotic syndrome.

Question 33

TTT of **Minimal Change Disease**

Answer 33

① Corticosteroids are the treatment of choice. ② Treatment of the cause if present.

Question 34

Prognosis of **Minimal Change Disease**

Answer 34

- Higher rate of remission after steroid treatment, with better long-term kidney outcomes.

Question 35

Etiology of **FSGS**

Answer 35

Question 36

Pathology in **FSGS**

Answer 36

Question 37

Presentation of **FSGS**

Answer 37

**① Hematuria** ② Hypertension ③ Any level of proteinuria ④ Renal insufficiency.

Question 38

TTT of **FSGS**

Answer 38

① Treatment of the cause. ② BP control with ACEIs/ARBs & salt restriction. ③ Corticosteroids/immunosuppressives.

Question 39

Etiology of **Membranous Glomerulonephritis**

Answer 39

Question 40

Pathology in **Membranous Glomerulonephritis**

Answer 40

Question 41

Presentation of **Membranous Glomerulonephritis**

Answer 41

Nephrotic syndrome.

Question 42

INVx for **Membranous Glomerulonephritis**

Answer 42

① Investigations for nephrotic syndrome diagnosis (see later) ② Investigations for secondary causes (e.g., SLE) ③ Anti-PLA2R antibodies in primary form.

Question 43

TTT of **Membranous Glomerulonephritis**

Answer 43

① Treatment of the cause. ② BP control with ACEIs/ARBs. ③ Corticosteroids + immunosuppressives.

Question 44

Etiology of **MPGN**

Answer 44

Question 45

Etiology of **MPGN** - Immunocomplex mediated

Answer 45

associated with: 1) Chronic infections (e.g., HCV - HBV - SBE). 2) Autoimmune diseases (e.g., SLE - RA). 3) Monoclonal gammopathies (e.g., Multiple myeloma).

Question 46

Etiology of **MPGN** - Complement mediated

Answer 46

dysregulation in the complement pathway

Question 47

Etiology of **MPGN** - MPGN without immunocomplex or complement.

Answer 47

....

Question 48

Pathology of **MPGN**

Answer 48

Question 49

Presentation of **MPGN**

Answer 49

① Nephrotic syndrome ② Nephritic syndrome ③ Nephritic-nephrotic.

Question 50

Done

Answer 50

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