Nephritic syndrome

Question 1

Microscopic heamaturia - how many times do you need to pick this up before you Investigate?

Answer 1

> trace on 3 occasions

Question 2

false positives of heamaturia include?

Answer 2

Haemaglobinuria, myoglobinuria

stix positive + microscopy negative

Question 3

Associated proteinuria =?

Answer 3

glomerular disease

Question 4

causes of haematuria? - systemic

Answer 4

clotting disorders

Question 5

most common cause of renal frank haematuria ?

Answer 5

Glomerulonephritis

Question 6

2 types of renal tumour?

Answer 6

Wilm’s - nephroblastoma

• Cysts
• sarcomas

Question 7

common causes of haematuria? (5)

Answer 7

Malignancies - sarcomas
Stones
UTI
Trauma
Urethritis

Question 8

how may it present? - case

Answer 8

10 years old
7 day history of sore throat, pyrexia and vomiting
Abdominal/lumbar pain, no radiation
GP treated as UTI
Day 7 of illness “red” urine
Some urgency, frequency but no dysuria

Hypertension
BP 130 /85
Water handling problem
Raised JVP
Peripheral oedema
Pallor
Abdomen – non tender, no organomegaly

Urine
Frank
dipstix Blood 3+, protein 3+
Red cells on microscopy

Question 9

how to approach a diagnosis of nephritic syndrome?

Answer 9

• blood tests - raised creatinine
• electrolytes - hyponatraemia and hyperkalaemia
• FBC - Mild anaemia, no haemolysis
• Albumin low
• urine work up to exclude UTI

Question 10

Clinical features of glomerulonephritis

Answer 10

Haematuria and proteinuria
Reduced GFR
Oliguria 
Fluid overload
Raised JVP
oedema
Hypertension
Worsening renal failure = Rapidly Progressive GN

= cause of AKI

Question 11

Endothelial cell injuries include?

Answer 11

• post infectious glomerulonephritis (PIGN),

- Haemolytic Uraemic Syndrome, - Membranoproliferative - - Glomerulonephritis (MPGN), Lupus, ANCA vasculitis

Question 12

investigations for nephritic syndrome?

Answer 12

• Renal USS
• infectious/sore throat - swab for group A strep
• immunology work up complement C3 AND C4
• ANA and ANCA

Question 13

Features of Acute Post-Infectious Glomerulonphritis

• cause?
  site?

Answer 13

age 3-5

• group a strep - beta hemolytic

throat infection , skin

Question 14

Pathogenesis of nephritic syndrome?

Answer 14

• Antigen “Mimicry”

- Ab-Ag complexes

Question 15

How to diagnose Acute Post-Infectious Glomerulonphritis?

differentials (4)

Answer 15

Bacterial culture
positive ASOT
low C3 normalises

• lupus, MPGN, HSP / IgA nephropathy,

Question 16

Treating Acute Post-Infectious Glomerulonphritis?

Answer 16

• Antibiotic - penicillin
• Support renal functions
• Electrolyte / acid base
  Overload / hypertension
  Diuretics

Question 17

IgA often presents after a?

Answer 17

URTI

- Older children and adults

Question 18

Clinical signs of IgA Nephropathy? (3)

Answer 18

• Recurrent macroscopic haematuria
• Chronic microscopic haematuria
• Varying degree of proteinuria

Question 19

Step 1 in IgA nephropathy pathogenesis

Answer 19

increased levels of Gd-IgA1

Question 20

Step 2 in IgA nephropathy pathogenesis

Answer 20

production of anti-IgA1 antibodies

IgA or IgG

Question 21

Step 3 in IgA nephropathy pathogenesis

Answer 21

IMMUNE COMPLEXES FORM

- FORM IN SITU

Question 22

Step 4 in IgA nephropathy pathogenesis

Answer 22

complexes in the mesangium cause local immune activation and injury

Question 23

what is caused/ what conditions are a result of antigens deposited in the kidneys? (6)

Answer 23

complement activation
cytokine release
matrix production 
mesangial proliferation 
glomerular sclerosis 
interstitial fibrosis

Question 24

How to diagnose IgA nephropathy ?

Answer 24

clinical pictire

- renal biopsy if needed

Question 25

treatment of IgA nephropathy - mild

Answer 25

ACEI - for proteinuria and hypertension

Question 26

treatment of IgA nephropathy - severe?

Answer 26

immunosuppresion (KDIGO)

Question 27

IgA related vasculitis - clinical feature - what do you need to diagnose?

Answer 27

Mandatory palpable purpura - Abdominal pain 2. Renal involvement 3. Arthritis or arthralgia 4. Biopsy - IgA depostition

Question 28

what vessels does IgA vasculitis affect

Answer 28

arterioles capillaries venules

Question 29

Cause of IgA vasculitis ?

Answer 29

Viral URTI in 70% | Streptococcus, drugs

Question 30

what cells are injured in IgA conditions?

Answer 30

Mesangial

Question 31

Treatments of IgA Vasculitis?

Answer 31

analgesia -Joints, gut antacids, Glucocorticoid therapy - gut symptoms severe - immunospression