Glomerulonephritis

Question 1

What is Glomerulonephritis?

Answer 1

inflammation of glomeruli in kidney

Question 2

what is the filter barrier in the glomerulus made up of?

Answer 2

endothelial cell cytoplasm

basal lamina

podocyte

Question 3

what are mesangial cells?

Answer 3

‘tree-like’ group of cells which support capillaries

Question 4

Outline the classification of glomerulonephritis

Answer 4

Primary - only kidneys involved

Secondary- kidneys involved as part of disease affecting other parts of body

Question 5

in glomerulonephritis, what is the most likely presentation of haematuria?

Answer 5

microscopic

Question 6

Ix for glomerulonephritis?

Answer 6

• Bloods
  
  • ​renal profile
  • blood film
  • ABG- metabolic acidosis
  • C3&C4- low
  • antibodies
    
    • ANA
    • C & P ANCA
    • Anti-GBM
    • ASO titres
• Urine
  
  • ​24hr urine collection
  • urine dipstick
  • urine MC&S
  • protein & Cr clearance
• Imaging
  
  • ​Renal tract USS
• Histology
  
  • ​renal biopsy

Question 7

Outline features of Nephritic Syndrome

Answer 7

Proteinuria (none or minimal)

Haematuria

Azotaemia

Red cell casts

Anti-strepsolysin O titres

Oliguria

Hypertension​

Question 8

what are the features of nephrotic syndrome?

Answer 8

• oedema
• proteinuria
• hypoalbuminaemia
• hyperlipidaemia

Question 9

what are the 2 main categories of glomerulonephritis and what is their definition?

Answer 9

• proliferative - excessive numbers of cells in glomeruli
• non-prolfierative - glomeruli look normal or have areas of scarring. Normal numbers of cells.

Question 10

What are the types of proliferative glomerulonephritis? (4 categories and 2 subtypes)

Answer 10

• IgA nephropathy
• Rapidly Progressive (crescentic) Glomerulonephritis
• Granulomatosis w Polyangiitis
• Microscopic polyangiitis
• Goodpasture’s syndrome
• Mesangio-capillary glomerulonephritis
• Post-infective glomerulonephritis

Question 11

how does proliferative glomerulonephritis usually present? ie nephrotic or nephritic

Answer 11

NEPHRITIC syndrome

Question 12

describe IgA nephropathy ie:

• epidemiology
• histology
• prognosis

Answer 12

• most common cause of primary GN
• peak age= 20s
• on histology
  
  • IgA deposits & glomerular mesangial proliferation
• self-limiting but ACEI significantly improve outcome

Question 13

when does IgA nephropathy typically develop?

Answer 13

After an infection (soon after- maybe 2-3days ago) parituclarly URTI/GI, as levels of IgA in blood will be elevated

Question 14

Describe post infective glomerulonephritis

Answer 14

aka diffuse proliferating GN

• occurs 1-3weeks post strep infection
• haematuria –> smoky urine
• mild HT
• raised ASOT
• Rx= supportive
• resolves over 6-8weeks

Question 15

what group of bacteria trigger post infective glomeurlonephritis ?

Answer 15

mainly group A streptococci ie strep pyogenes

Question 16

Pathology + Aetiology of Mesangio-capillary glomerulonephritis

Answer 16

Pathology:

subendothelial deposition of immune complexes –> mesangium AND basement membrane thickened

this is a crossover between nephrotic AND nephritic picture!!

Aetiology:

Hep C

Hep B

Question 17

Describe Rapidly Progressive (crescentic) glomerulonephritis

Answer 17

NOT a type of GN- it is a histological description

• v acute illness w sick patients
• medical emergency- rapidly progresses to esrf
• responds well to Rx if started early enough
• occurs due to
  
  • goodpastures syndrome
  • wegeners or MP
  • complication of other types of GN

Question 18

what is Wegener’s granulomatosis?

Answer 18

a form of vasculitis affecting the lungs, kidneys and nose

Question 19

how does Wegener’s present?

Answer 19

nasal sniffles, penumonia like symptoms and acute renal failure

Question 20

what could be done to test for Wegener’s?

Answer 20

ANCA - c-ANCA positive in most cases

Question 21

What is treatment for Wegener’s?

Answer 21

Cyclophosphamide

Question 22

What is microscopic polyangitis?

Answer 22

a small vessel vasculitis affecting any organ system

Question 23

what test could be done to test for microscopic polyangitis?

Answer 23

ANCA - P-ANCA positive in most cases

Question 24

What is Goodpasture’s Syndrome caused by?

Answer 24

• circulating anti-GBM (glomerular basement membrane) antibodies, that attack glomerulus & pulmonary basement membranes
• this causes glomerulonephritis & pulmonary haemorrhage
  
  • will present as haematuria + haemoptysis

Question 25

if no haemoptysis, but only renal failure, what would it be called?

Answer 25

anti-GBM glomerulonephritis

Question 26

What is treatment of Good pastures Syndrome?

Answer 26

Plasma exchange + immunosuppression

Question 27

What are the 3 types of non-proliferative glomerulonephritis?

Answer 27

* minimal change disease * focal and segmental glomerulosclerosis * membranous nephropathy

Question 28

how do non-proliferative glomerulonephritis usually present?

Answer 28

nephrotic syndrome

Question 29

outline some other causes of nephrotic syndrome, other than glomerulonephritis

Answer 29

* amyloid * long-standing DM * SLE

Question 30

what is the general Mx of nephrotic syndrome?

Answer 30

* oedema - salt and fluid restriction + loop diuretics * proteinuria- ACEI * hyperlipidaemia- Statins

Question 31

Describe **minimal change glomerulonephritis**

Answer 31

* mainly in kids * responds to steroids * idiopathic usually

Question 32

Epi and aetiology of **Focal & Segmental Glomerulosclerosis**

Answer 32

epi: most common cause of nephrotic syndrome in adults aetiology: Heroin, HIV, Pamidronate

Question 33

what is treatment for Focal & Segmental Glomerulosclerosis?

Answer 33

* general measures * trial steroids BUT often steroid resistant * alternatively: immunosuppression * if creatinine still rising, transplant

Question 34

epidemiology of **membranous nephropathy**

Answer 34

* most common type of GN overall * bimodal age peak : 20s and 60s

Question 35

What causes membranous nephropathy? ie pathology

Answer 35

* IgG deposits on BM * this results in complement activation against glomerular basement membrane * complement 'punches holes' in basement membrane * leaky filter= nephrotic syndrome

Question 36

aetiology of membranous nephropathy

Answer 36

* mostly idiopathic * some occur secondary to other causes: * lupus * malignancy * lung, colon, haematological * hep B/C * RA * drugs

Question 37

What is seen on immunofluorescence in membranous nephropathy?

Answer 37

spikes around deposits

Question 38

what investigation could be done for membranous nephropathy?

Answer 38

Anti-phospholipase A2 receptor antibody positive typically

Question 39

what is treatment for membranous nephropathy?

Answer 39

* steroids * immunosuppression if persistent symptomatic