1
Q
A
Glomeruli
Nephrons
2
Q
A
glomeruli damage
3
Q
A
compensatory BP rise
4
Q
A
Proteinuria
Haematuria
(mild –> nephrotic/macroscopic)
5
Q
A
Hypertension
urine dipstick findings (2)
Renal function impaired
6
Q
A
proteinuria (3.5g/day)
7
Q
A
> 3.5g/day
8
Q
A
normal or raised (mild)
9
Q
A
normal or raised (mild)
10
Q
A
normal/mild raised BP
normal/mild raised GFR
>3.5g/day protein
11
Q
A
Moderate/severely raised BP
Moderate/severely raised GFR
Haematuria
12
Q
A
Blood
mild to macro
13
Q
A
Nephrotic
Nephritic syndrome
14
Q
A
Mesangiocapillary GN
15
Q
A
Mesangium
Basement membrane
16
Q
A
Immune complex mediated
Complement mediated
17
Q
A
classical
18
Q
A
C
19
Q
A
alternative
20
Q
A
proliferated mesangium
thickened basement membrane
21
Q
A
complement stains
light chains
Ig stains
22
Q
A
ACEi/ARB
23
Q
A
T
24
Q
A
steroids
+-
cyclophosphamide
(immunosuppression)
25
[GN]: Mesangiocapillary GN: can this relapse and cause transplant failure?
Yes
26
[GN]: Mesangiocapillary GN: when is an immunosuppressive regimens of steroids (+- cyclophosphamide) indicated
rapid deterioration of renal function
27
[GN]: what are the 2 primary causes of nephritic syndrome
mesangiocapillary GN
| IgA nephropathy
28
[GN]: what is the commonest GN cause in the West?
IgA nephropathy
29
[GN]: IgA nephropathy presents with
Haematuria
| marked nephritic in fewer
30
[GN]: IgA: what is the timecourse of haematuria
relapsing and remitting (rapid recovery between attacks)
31
[GN]: IgA: more common in men/women?
men
32
[GN]: IgA: common age of onset?
young
33
[GN]: IgA: typical picture of IgA
Western young man with attacks of haematuria
34
[GN]: IgA: IgA deposition occurs on the ... cells
mesangial
35
[GN]: IgA: what would be seen on renal biopsy
mesangial proliferation
36
[GN]: IgA: what would be seen on immunofluorescence of biopsy (2)
IgA
| C3
37
[GN]: IgA: 1st tx in ALL.
ACEi/ARB
38
[GN]: IgA: what might be an indication for immunosuppressive regimens
marked decline in renal function
39
[GN]: what are the 4 primary causes of nephrotic syndrome
Mesangiocapillary GN
Membranous GN
Minimal change
Focal segmental glomerularsclerosis
40
[GN]: what are the 4 common secondary causes of nephrotic syndrome
Diabetes
Amyloid
SLE (class 5)
Hepatitis B and C
41
[GN]: which hepatitis' can cause nephrotic syndrome (2)
B
| C
42
[GN]: what class of SLE can cause nephrotic syndrome
V (5)
43
[GN]: there are 5 classes of SLE nephritides. Which class can cause nephritic syndrome (4)
1 to 4
44
[GN]: what does amyloid deposit
abnormal protein in fibrillar form
45
[GN]: what effect does amyloid deposition have on the glomerulus
glomerular lesions
46
[GN]: how does hepatitis cause renal damage and nephrotic syndrome?
antigen deposition on glomerulus
host reaction
immune complex deposition
47
[GN]: what 5 secondary causes of nephritic syndrome are there?
```
SLE (1-4)
Vasculitis
Anti-GBM
Cryoglobulinaemia
Post-streptococcal
```
48
[GN]: If haematuria is seen up to 12 week after a throat infection/skin infection which secondary causes of nephritic syndrome is suspected?
post-streptococcal
49
[GN]: Describe how does post-streptococcal nephrititic syndrome occur?
antigen deposition on glomerulus
host reaction
immune complex deposition
50
[GN]: what may be seen on serology in post-streptococcal GN?
raised ASOT
| raised C3
51
[GN]: Why is it rare to investigate post-streptococcal GN?
Not required usually
95% recover with supportive Tx
Cure infection!
52
[GN]: what does ASOT stand for?
anti-streptolysin O
| (o = oxygen labile)
53
[GN]: What is ASOT?
An antibody against streptolysin O: an antigen produced by group A streps
54
[GN]: what is the function of streptolysin
beta-haemolysis (RBC haemolysis full)
55
[GN]: post-streptococcal GN produces ... proliferation
a diffuse
56
[GN]: define cyroglobulins
proteins which become insoluble at lower temperature
57
[GN]: what is the most common cryoglobulin
Immunoglobulins
58
[GN]: anti-GBM: aka
Goodpastures disease
59
[GN]: anti-GBM: what are the auto-antibodies directed against in Goodpasture's disease
type IV collagen
60
[GN]: anti-GBM: the glomerular basement membrane contains type ... collagen
IV (4)
61
[GN]: anti-GBM: where in the body is type IV collagen found (2)
Renal glomerulus
| Lung tissue
62
[GN]: anti-GBM: what lung complication can occur in Goodpasture's disease
pulmonary haemorrhage
63
[GN]: anti-GBM: which group of people are at increased risk of pulmonary complications?
smokers
64
[GN]: anti-GBM: how do they present
nephritic/haematuria
65
[GN]: anti-GBM: what can Goodpasture's progress to
AKI (within days)
66
[GN]: anti-GBM: what is Tx for Goodpastures? (3)
```
plasma exchange (removes antibodies)
+
steroids
+-
cyclophosphamide
```
67
[GN]: how does cyclophosphamide work
adds alkyl group to DNA - prevent synthesis
| nitrogen mustard alkylating agent
68
[GN]: vasculitis: which vasculitis is most associated with GN
ANCA +ve
69
[GN]: vasculitis: what does ANCA stand for
anti-neutrophil cytoplasmic antibody
70
[GN]: vasculitis: what doe ANCAs targets
neutrophils
71
[GN]: vasculitis: ANCA + vasculitides can causes GN by damaging glomerulus by causing ... deposition/attack
neutrophil
72
[GN]: what is the systemic variant of IgA nephropathy?
Henloch-Schonlein purpura
73
[GN]: Henloch-Schonlein purpura: what type of vasculitis does this cause
small vessel vasculitis
74
[GN]: Henloch-Schonlein purpura: what is the main pathology of this IgA variant
small vessel vasculitis
75
[GN]: Henloch-Schonlein purpura: where on the body is do the purpura (due to small vessel vasculitis) present?
extensor surfaces
| legs
76
[GN]: Henloch-Schonlein purpura: what 4 signs/symptoms are there of HSP
extensor surface purpura
polyarthritis (can be flitting)
Abdominal pain (GI bleed)
nephritis
77
[GN]: Henloch-Schonlein purpura: what would a skin or renal biospy show
IgA depostion
| identical to IgA nephropathy
78
[GN]: Henloch-Schonlein purpura: 1st line
ACEi
| steroids
+-
cyclophosphamide
if progressive renal dysfunction
79
[GN]: what antibodies would you check for in a GN (5)
```
anti-GBM
anti-dsDNA (SLE)
ANA (SLE)
ANCA (vasculitis)
Anti-HCV (Hep C)
```
80
[GN]: How would you check for Hep B
HBsAg (Hep B surface antigen)
81
[GN]: What would Bence Jones proteins be indicative of?
Multiple myeloma
| it is a light chain
82
[GN]: what is the gold standard for Dx
renal biopsy
| no need in Post-strep
83
[GN]: General Tx: below what BP should you aim for
1g/day
84
[GN]: General Tx: below what BP should you aim for if proteinuria is >1g/day
<75
85
[GN]: General Tx: what 1st line Tx can reduce proteinuria in almost all cases (and preserve renal Fx)
ACEi/ARB
86
[GN]: What is the commonest cause of ESRF in adults?
GN!
87
[GN]: Rapidly progressing GN: how quickly can this group cause ESRF?
days
88
[GN]: Rapidly progressing GN: what characteristic on biopsy are seen in this group?
Crescents affecting most glomeruli
89
[GN]: Rapidly progressing GN: how many categories of RPGN are there?
3
90
[GN]: Rapidly progressing GN: what are the 3 categories of RPGN
Immune complex (47%)
Pauci-immuni (50%)
Anti-GBM (3%)
91
[GN]: Rapidly progressing GN: give 3 examples of immune complex RPGN
IgA
HSP
Post-strep
SLE
92
[GN]: Rapidly progressing GN: ANCA vasculitides belong to which category of RPGN
pauci immune
93
[GN]: Rapidly progressing GN: this group is represented by the most aggressive GNs? T/F
T
94
[GN]: Rapidly progressing GN: what is biggest risk in ANCA +ve pts
pulmonary haemorrhage
95
[GN]: Rapidly progressing GN: is AKI a feature
yes
96
[GN]: Rapidly progressing GN: what is the Tx for RPGN?
IV steroids
+
cyclophosphamide
+- plasma exhange
RENAL
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