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Questions and Answers
What is a common cause of acute postinfectious glomerulonephritis (APIGN)?
What is a common cause of acute postinfectious glomerulonephritis (APIGN)?
Lupus nephritis is caused by bacterial infections.
Lupus nephritis is caused by bacterial infections.
False
What occurs to the glomerular filtration rate (GFR) during acute proliferative glomerulonephritis?
What occurs to the glomerular filtration rate (GFR) during acute proliferative glomerulonephritis?
It decreases.
Nephritis is primarily characterized by inflammation of the __________.
Nephritis is primarily characterized by inflammation of the __________.
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Match the type of nephritis with its associated characteristic:
Match the type of nephritis with its associated characteristic:
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Which organism is not commonly associated with causing acute postinfectious glomerulonephritis?
Which organism is not commonly associated with causing acute postinfectious glomerulonephritis?
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Antibody-antigen complexes in the glomeruli lead to thickening of glomerular membranes.
Antibody-antigen complexes in the glomeruli lead to thickening of glomerular membranes.
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What is one consequence of the increased vascular permeability during nephritis?
What is one consequence of the increased vascular permeability during nephritis?
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Which cell types are primarily involved in the inflammatory response in the glomerular membrane?
Which cell types are primarily involved in the inflammatory response in the glomerular membrane?
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Chronic glomerulonephritis can often be recognized immediately after symptoms develop.
Chronic glomerulonephritis can often be recognized immediately after symptoms develop.
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What is one major cause of morbidity and mortality associated with systemic lupus erythematosus (SLE)?
What is one major cause of morbidity and mortality associated with systemic lupus erythematosus (SLE)?
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Chronic glomerulonephritis typically results in __________ in kidney size and creates a granular appearance on the surfaces.
Chronic glomerulonephritis typically results in __________ in kidney size and creates a granular appearance on the surfaces.
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Match the following types of nephritis with their corresponding etiology:
Match the following types of nephritis with their corresponding etiology:
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Which factors can trigger disease development in anti-GBM disease?
Which factors can trigger disease development in anti-GBM disease?
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The majority of patients with SLE develop lupus nephritis.
The majority of patients with SLE develop lupus nephritis.
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What test can be used for the diagnosis of anti-GBM disease?
What test can be used for the diagnosis of anti-GBM disease?
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The treatment of choice for anti-GBM disease includes __________ to remove damaging antibodies from the plasma.
The treatment of choice for anti-GBM disease includes __________ to remove damaging antibodies from the plasma.
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Which population is more likely to develop lupus nephritis?
Which population is more likely to develop lupus nephritis?
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Nephritis can only arise from previous glomerular diseases.
Nephritis can only arise from previous glomerular diseases.
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Name one environmental factor that can increase the risk of nephritis.
Name one environmental factor that can increase the risk of nephritis.
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A significant increase in __________ permeability allows proteins and red blood cells to pass into urine in glomerular injury.
A significant increase in __________ permeability allows proteins and red blood cells to pass into urine in glomerular injury.
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Match the following symptoms or consequences with their related nephritis condition:
Match the following symptoms or consequences with their related nephritis condition:
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Which of the following is NOT a clinical manifestation of nephritis?
Which of the following is NOT a clinical manifestation of nephritis?
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Sodium restriction is part of the clinical therapy for nephritis.
Sodium restriction is part of the clinical therapy for nephritis.
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What is a common emergency treatment for severe hypertension in nephritis?
What is a common emergency treatment for severe hypertension in nephritis?
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The presence of ________ is a clinical manifestation that may indicate a need for antibiotics in nephritis.
The presence of ________ is a clinical manifestation that may indicate a need for antibiotics in nephritis.
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Match the clinical therapies to their respective clinical manifestations in nephritis:
Match the clinical therapies to their respective clinical manifestations in nephritis:
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Which of the following symptoms is commonly associated with acute postinfectious glomerulonephritis?
Which of the following symptoms is commonly associated with acute postinfectious glomerulonephritis?
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Puffiness of the face is a symptom mostly seen at night in acute glomerulonephritis.
Puffiness of the face is a symptom mostly seen at night in acute glomerulonephritis.
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What condition may result from sodium and water retention due to acute glomerulonephritis?
What condition may result from sodium and water retention due to acute glomerulonephritis?
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Acute glomerulonephritis can lead to decreased _________ due to kidney dysfunction.
Acute glomerulonephritis can lead to decreased _________ due to kidney dysfunction.
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Match the following symptoms with their related description:
Match the following symptoms with their related description:
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What is a common urine appearance associated with acute postinfectious glomerulonephritis?
What is a common urine appearance associated with acute postinfectious glomerulonephritis?
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Which symptom is typically NOT associated with acute glomerulonephritis?
Which symptom is typically NOT associated with acute glomerulonephritis?
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As acute glomerulonephritis progresses, which of the following is the most likely symptom to manifest?
As acute glomerulonephritis progresses, which of the following is the most likely symptom to manifest?
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Which of the following complications may arise from acute hypertension associated with acute glomerulonephritis?
Which of the following complications may arise from acute hypertension associated with acute glomerulonephritis?
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What clinical manifestation is primarily noted in the face during acute glomerulonephritis?
What clinical manifestation is primarily noted in the face during acute glomerulonephritis?
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Which therapy is considered emergency care for severe hypertension resulting from nephritis?
Which therapy is considered emergency care for severe hypertension resulting from nephritis?
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What clinical manifestation is commonly associated with sodium and water retention in nephritis?
What clinical manifestation is commonly associated with sodium and water retention in nephritis?
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Which of the following is NOT a part of the clinical therapy for nephritis?
Which of the following is NOT a part of the clinical therapy for nephritis?
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Which symptom may indicate the presence of infection in a nephritis patient?
Which symptom may indicate the presence of infection in a nephritis patient?
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What is a common condition resulting from acute hypertension associated with nephritis?
What is a common condition resulting from acute hypertension associated with nephritis?
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Study Notes
Nephritis
- Inflammation of the kidneys
- Classified based on affected area or cause
Glomerulonephritis
- Inflammation of the glomerular capillary membrane
- Can be caused by infections like strep throat, skin infections, and certain viruses
- Can also be caused by autoimmune disorders like Lupus
Acute Postinfectious Glomerulonephritis (APIGN)
- May develop after a Group A Beta-hemolytic Streptococcal infection
- Common infections include impetigo and strep throat
- Other potential causes include Staphylococcus, Pneumococcus, and Coxsackie Virus
Lupus Nephritis
- Occurs in patients with Systemic Lupus Erythematosus (SLE)
- Caused by an autoimmune attack on the kidneys
- Can lead to significant damage to the kidneys
Pathophysiology
- Antibody-antigen complexes deposit in the glomerular capillary wall
- Triggers an inflammatory response, leading to thickening of glomerular membranes
- This thickening obstructs capillaries and reduces glomerular filtration rate (GFR)
- Damage to the glomerular-capillary area increases vascular permeability allowing protein and red blood cells to leak out
- Protein loss alters osmotic pressure in the vascular system
- Sodium and water retention leads to edema
Chronic Glomerulonephritis
- Often the end stage of other glomerular disorders like rapidly progressive glomerulonephritis (RPGN), lupus nephritis, and diabetic nephropathy
- Characterized by slow, progressive destruction of the glomeruli and decline in renal function
- Kidneys decrease in size and become granular or roughened
Anti-Glomerular Basement Membrane Disease (Anti-GBM Disease)
- Uncommon, complex disorder where autoantibodies attack the lungs and kidneys
- Early recognition and treatment are critical for the recovery of renal function
- Linked to genetic susceptibility and environmental factors like smoking, infections, and exposure to certain substances
Diagnosis of Anti-GBM Disease
- Based on a review of symptoms, physical examination, laboratory findings, kidney biopsy, and chest x-ray
- Laboratory tests may show elevated serum creatinine and BUN levels
- Urinalysis may show blood and protein in the urine
Treatment of Anti-GBM Disease
- Combination of plasmapheresis and immunosuppression to remove circulating anti-GBM antibodies
Etiology of Nephritis
- Lupus nephritis is caused by SLE, an autoimmune disorder
- Glomerulonephritis can also result from infection, diabetes mellitus, or SLE
- Tubulointerstitial nephritis can occur secondary to glomerular damage (from drugs, toxins, or radiation) and renovascular disease
Risk Factors for Nephritis
- Diabetes mellitus and hypertension increase risk due to vascular damage to the nephrons
- Infections can travel from the bladder to the kidney or cause scarring leading to urine retention and nephron damage
- Drug abuse and overuse of analgesics also increase the risk
- Black populations have a higher incidence of lupus and nephritis
- Hispanics and Asian Americans have greater frequency and severity of nephritis compared to whites
- Prematurity, trauma, and family history of kidney disease can also contribute
- Diseases like SLE, sickle cell disease, AIDS, and congestive heart failure can damage the kidneys
- Prematurity, trauma, and family history of kidney disease can also contribute
Prevention
- Preventing viral infections through good hygiene
- Controlling diabetes and blood pressure
- Quitting smoking
- Maintaining a healthy body weight
- Early management of underlying conditions
### Acute Glomerulonephritis (GN)
- Can initially be subtle with microscopic hematuria and proteinuria, which may resolve or worsen.
- Common symptoms include abdominal or flank pain, fever, fatigue, and facial puffiness in the morning.
- As the disease progresses, edema can worsen, especially in the lower legs and ankles during the day.
- Shortness of breath due to pulmonary edema may occur.
- Decreased urination is also a symptom.
- Acute hypertension can lead to increased intracranial pressure, manifesting as headache, nausea, and vomiting.
Acute Postinfectious Glomerulonephritis
- Characterized by an abrupt onset of hematuria, proteinuria, sodium and water retention, and azotemia.
- Occurs 10 to 14 days after the initial infection.
- Urine often appears brown or cola-colored.
- Sodium and water retention increase extracellular fluid volume, causing hypertension and edema.
- Facial edema, particularly around the eyes, is common.
- Dependent edema in the hands and upper extremities can occur.
- Other symptoms include fatigue, anorexia, nausea and vomiting, and headache.
Clinical Therapies
-
Sodium and Water Retention, HTN, Mild to Moderate Edema.
- Diuretics
- Antihypertensives
- Sodium restriction
- Low-protein diet
-
Severe HTN
- Extremely high blood pressure with cerebral dysfunction.
- Emergency care with IV diazoxide, hydralazine, or labetalol.
-
Progressive Edema, Acute Inflammatory Processes
- Ascites
- Pulmonary effusion
- Immunosuppressive therapy (cyclophosphamide, azathioprine).
- Corticosteroids
- Sodium restriction
-
Encephalopathy due to Acute HTN
- Headache
- Nausea and vomiting
- Irritability
- Antihypertensives
- Analgesics
- Additional therapies as needed.
-
Presence of Infection
- Sodium and water retention
- Fever
- Malaise
- Edema
- Antibiotics
- Bed rest
- Sodium restriction
- Antipyretics
Acute Glomerulonephritis
- Early signs may be subtle, with microscopic hematuria (blood in the urine) and proteinuria (protein in the urine), which can resolve on their own or progress.
- Abrupt onset of symptoms may include abdominal or flank pain, fever, tiredness, facial puffiness in the morning.
- As the disease progresses, edema (swelling) increases, especially in the lower legs and ankles during the day, shortness of breath due to pulmonary edema (fluid in the lungs), and decreased urination.
- Acute hypertension (high blood pressure) can occur, with signs like headache, nausea, and vomiting.
- Acute postinfectious glomerulonephritis is characterized by an abrupt onset of hematuria, proteinuria, sodium and water retention, and azotemia (abnormally high levels of nitrogen waste products in the blood) occurring 10 to 14 days after the initial infection.
- Urine may appear brown or cola-colored.
- Sodium and water retention increase extracellular fluid volume, leading to hypertension and edema.
- Edema is primarily noted in the face, particularly around the eyes, and in the hands and upper extremities.
- Other manifestations include fatigue, anorexia, nausea, vomiting, and headache.
Management of Glomerulonephritis
-
Sodium and water retention, mild to moderate edema, and hematuria:
- Diuretics
- Antihypertensives
- Sodium restriction
- Low-protein diet
-
Severe hypertension, extremely high blood pressure with cerebral dysfunction:
- Emergency care with IV diazoxide, hydralazine, or labetalol.
- **Progressive edema, acute inflammatory processes such as ascites (fluid buildup in the abdomen) and pulmonary effusion (fluid buildup in the lungs): **
- Immunosuppressive therapy (cyclophosphamide, azathioprine)
- Corticosteroids
- Sodium restriction
-
Encephalopathy (brain dysfunction) resulting from acute hypertension:
- Headache
- Nausea and vomiting
- Irritability
- Antihypertensives
- Analgesics
- Additional therapies as needed
-
Presence of infection:
- Sodium and water retention
- Fever
- Malaise
- Edema
- Antibiotics
- Bedrest
- Sodium restriction
- Antipyretics (fever reducers)
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Description
This quiz covers the key concepts related to nephritis and its various forms, including glomerulonephritis and lupus nephritis. Explore the causes, symptoms, and pathophysiology associated with these kidney conditions. Test your knowledge on the impact of infections and autoimmune disorders on kidney health.
