Acute Disorders (PEARLS) Glomerulonephritis, Nephrotic
Syndrome, and Pyelonephritis Test Questions and Answers
What are the characteristics of glomerular infection in most cases. A trial of steroids may be
disease?- Proteinuria, hematuria indicated if renal failure is severe. There is no
(microscopic or gross), renal insufficiency, and evidence supporting aggressive
HTN. Depending upon the cause, systemic immunosuppression.
symptoms may also be present.
What is the prognosis of postinfectious GN?-
A 10 y/o is brought to the clinic with her mother Self-limited, with Cr returning to baseline in
for dark urine. The mother mentions that the child <6 weeks in most cases; hematuria typically
was complaining of sore throat and cough/cold resolves within 6 months. 15% of patients with
symptoms two ago. The urine shows gross poststreptococcal GN have persistent proteinuria
hematuria without nitrites or leukocytes.- at 3 years, 2% at 7–10 years. Progression to
Postinfectious (Poststreptococcal) ESRD is rare, as is recurrence.
glomerulonephritis
A 33-year-old man comes to the ED because of
What is the typical clinical presentation of blood in his urine for 2 days. He has also been
postinfectious GN?- Presentation varies feeling unwell, with a sore throat, running nose,
from asymptomatic with only microscopic cough, and fever. Medical history includes three
findings on urinalysis to that of a nephritic episodes of hematuria in the past that have
syndrome: gross hematuria, HTN, edema, and spontaneously resolved. His temperature is
acute renal failure. Symptoms appear 2–3 weeks 98.9°F; pulse is 82/min; respirations are 18/min,
after streptococcal pharyngitis or other bacterial and blood pressure is 145/90 mm Hg. PE is
infection normal. Urinalysis shows moderate numbers of
erythrocytes, a few leukocytes, red cell casts,
What are the characteristic laboratory findings of and a large amount of protein. No bacteria are
postinfectious GN?- Urine sediment reveals cultured. A renal biopsy demonstrates large dark
dysmorphic RBCs or RBC casts and proteinuria mesangial deposits.- IgA nephropathy
(occasionally nephrotic range); serum studies are
remarkable for hypocomplementemia, positive What is the typical clinical presentation of IgA
ASO titer. nephropathy?- Gross hematuria with or
without proteinuria during viral upper respiratory
What are the renal biopsy characteristics for LM, tract infection or GI illness, persistent microscopic
IF, EM?- LM - Glomerular hypercellularity, hematuria, and sometimes associated dull flank
with epithelial and endothelial cell proliferation, pain, with a 2:1 male predominance, often
and an inflammatory glomerular infiltrate presenting in the second and third decades of life
composed of neutrophils. Capillary lumens are
usually obliterated. Crescents may be present. What are the most common conditions with which
IF - Granular deposition of IgG and C3 in the IgA nephropathy is associated?- Liver
glomerular tuft disease (e.g., alcoholic cirrhosis), inflammatory
EM - Large, irregular, subepithelial "hump"- bowel disease, celiac sprue, and HIV
shaped deposits
What are the characteristic laboratory findings of
What is the appropriate management of IgA nephropathy?- Normal or decreased
postinfectious GN?- No specific therapy renal function, persistent microhematuria, and
other than the treatment of the underlying variable proteinuria; urine sediment reveals
1/8
, Acute Disorders (PEARLS) Glomerulonephritis, Nephrotic
Syndrome, and Pyelonephritis Test Questions and Answers
dysmorphic RBCs and RBC casts
What are the most common causes of secondary
What are the renal biopsy characteristics of IgA MPGN?- Hepatitis B/C, cryoglobulinemia,
nephropathy for LM, IF, EM? - LM - Focal lupus, and HIV
or diffuse mesangial proliferation with matrix
expansion. Crescents may or may not be What are the characteristic laboratory findings of
present. MPGN?- Variable increase in BUN/serum
IF - Globular IgA deposition in the mesangium creatinine, anemia, low serum C3 or C4, and
and capillary walls presence of serum C3 nephritic factor (especially
EM - Electron dense mesangial deposits in type II). Urine sediment contains dysmorphic
RBCs, WBCs, and RBC casts
What is the appropriate management of IgA
nephropathy?- Most patients will benefit What are the renal biopsy characteristics of
from ACE-I or ARB to reduce proteinuria and BP, MPGN for LM, IF, EM? - LM - Thickening
as well as a statin. Patients with nephrotic range and "tram-tracking" (splitting) of GBM. Mesangial
proteinuria may also benefit from the addition of proliferation and interposition.
fish oil, while patients with more severe disease IF - Fine granular deposition of C3 and IgG
require immunosuppression deposition in the mesangium and along
peripheral capillary walls. EM - Mesangial
What is the of IgA nephropathy of IgA interposition and duplication of GBM. Immune
nephropathy?- Patients without proteinuria complex deposits are present; the location
and who have preserved GFR have a low risk of (mesangial, subendothelial, or subepithelial)
progressing to ESRD. Of patients who develop dictates the type of MPGN (I, II, or III)
proteinuria, 30% will progress slowly to ESRD
within 30 years What is the appropriate management of MPGN?-
Treatment of the underlying disease in
A 26-year-old man presents with hematuria, secondary MPGN is a mainstay of therapy.
periorbital edema, and jaundice. He has a Idiopathic disease can be treated with steroids or
medical history of opioid use disorder with prior antiplatelet agents, such as aspirin, clopidogrel,
hospitalizations for a heroin overdose. He is on or dipyridamole. Data are limited to support the
Suboxone but is non-adherent. His blood use of cytotoxic drugs
pressure is 162/102 mmHg. Physical
examination is significant for scleral icterus, What is the prognosis of MPGN?- Complete
hepatomegaly, and palpable purpura. Serology or partial remission can be induced in secondary
shows decreased C3 and C4 levels and elevated MPGN by the treatment of the underlying
anti-hepatitis C antibodies. Urinalysis disease. In patients with idiopathic MPGN, 50%-
demonstrates dysmorphic red blood cells and red 60% will develop ESRD in 10-15 years if left
blood cell casts - Membranoproliferative untreated. How frequently does MPGN recur in
glomerulonephritis (MPGN) the transplanted kidney and what is the outcome
if it does? Type I and type III recur in ~30% of
What is the typical clinical presentation of transplants
MPGN?- Variable decrease in renal
function, HTN, anemia, hematuria, and A 15-year-old boy comes to the office because of
proteinuria malaise, anorexia, nausea, and decreased
2/8
Syndrome, and Pyelonephritis Test Questions and Answers
What are the characteristics of glomerular infection in most cases. A trial of steroids may be
disease?- Proteinuria, hematuria indicated if renal failure is severe. There is no
(microscopic or gross), renal insufficiency, and evidence supporting aggressive
HTN. Depending upon the cause, systemic immunosuppression.
symptoms may also be present.
What is the prognosis of postinfectious GN?-
A 10 y/o is brought to the clinic with her mother Self-limited, with Cr returning to baseline in
for dark urine. The mother mentions that the child <6 weeks in most cases; hematuria typically
was complaining of sore throat and cough/cold resolves within 6 months. 15% of patients with
symptoms two ago. The urine shows gross poststreptococcal GN have persistent proteinuria
hematuria without nitrites or leukocytes.- at 3 years, 2% at 7–10 years. Progression to
Postinfectious (Poststreptococcal) ESRD is rare, as is recurrence.
glomerulonephritis
A 33-year-old man comes to the ED because of
What is the typical clinical presentation of blood in his urine for 2 days. He has also been
postinfectious GN?- Presentation varies feeling unwell, with a sore throat, running nose,
from asymptomatic with only microscopic cough, and fever. Medical history includes three
findings on urinalysis to that of a nephritic episodes of hematuria in the past that have
syndrome: gross hematuria, HTN, edema, and spontaneously resolved. His temperature is
acute renal failure. Symptoms appear 2–3 weeks 98.9°F; pulse is 82/min; respirations are 18/min,
after streptococcal pharyngitis or other bacterial and blood pressure is 145/90 mm Hg. PE is
infection normal. Urinalysis shows moderate numbers of
erythrocytes, a few leukocytes, red cell casts,
What are the characteristic laboratory findings of and a large amount of protein. No bacteria are
postinfectious GN?- Urine sediment reveals cultured. A renal biopsy demonstrates large dark
dysmorphic RBCs or RBC casts and proteinuria mesangial deposits.- IgA nephropathy
(occasionally nephrotic range); serum studies are
remarkable for hypocomplementemia, positive What is the typical clinical presentation of IgA
ASO titer. nephropathy?- Gross hematuria with or
without proteinuria during viral upper respiratory
What are the renal biopsy characteristics for LM, tract infection or GI illness, persistent microscopic
IF, EM?- LM - Glomerular hypercellularity, hematuria, and sometimes associated dull flank
with epithelial and endothelial cell proliferation, pain, with a 2:1 male predominance, often
and an inflammatory glomerular infiltrate presenting in the second and third decades of life
composed of neutrophils. Capillary lumens are
usually obliterated. Crescents may be present. What are the most common conditions with which
IF - Granular deposition of IgG and C3 in the IgA nephropathy is associated?- Liver
glomerular tuft disease (e.g., alcoholic cirrhosis), inflammatory
EM - Large, irregular, subepithelial "hump"- bowel disease, celiac sprue, and HIV
shaped deposits
What are the characteristic laboratory findings of
What is the appropriate management of IgA nephropathy?- Normal or decreased
postinfectious GN?- No specific therapy renal function, persistent microhematuria, and
other than the treatment of the underlying variable proteinuria; urine sediment reveals
1/8
, Acute Disorders (PEARLS) Glomerulonephritis, Nephrotic
Syndrome, and Pyelonephritis Test Questions and Answers
dysmorphic RBCs and RBC casts
What are the most common causes of secondary
What are the renal biopsy characteristics of IgA MPGN?- Hepatitis B/C, cryoglobulinemia,
nephropathy for LM, IF, EM? - LM - Focal lupus, and HIV
or diffuse mesangial proliferation with matrix
expansion. Crescents may or may not be What are the characteristic laboratory findings of
present. MPGN?- Variable increase in BUN/serum
IF - Globular IgA deposition in the mesangium creatinine, anemia, low serum C3 or C4, and
and capillary walls presence of serum C3 nephritic factor (especially
EM - Electron dense mesangial deposits in type II). Urine sediment contains dysmorphic
RBCs, WBCs, and RBC casts
What is the appropriate management of IgA
nephropathy?- Most patients will benefit What are the renal biopsy characteristics of
from ACE-I or ARB to reduce proteinuria and BP, MPGN for LM, IF, EM? - LM - Thickening
as well as a statin. Patients with nephrotic range and "tram-tracking" (splitting) of GBM. Mesangial
proteinuria may also benefit from the addition of proliferation and interposition.
fish oil, while patients with more severe disease IF - Fine granular deposition of C3 and IgG
require immunosuppression deposition in the mesangium and along
peripheral capillary walls. EM - Mesangial
What is the of IgA nephropathy of IgA interposition and duplication of GBM. Immune
nephropathy?- Patients without proteinuria complex deposits are present; the location
and who have preserved GFR have a low risk of (mesangial, subendothelial, or subepithelial)
progressing to ESRD. Of patients who develop dictates the type of MPGN (I, II, or III)
proteinuria, 30% will progress slowly to ESRD
within 30 years What is the appropriate management of MPGN?-
Treatment of the underlying disease in
A 26-year-old man presents with hematuria, secondary MPGN is a mainstay of therapy.
periorbital edema, and jaundice. He has a Idiopathic disease can be treated with steroids or
medical history of opioid use disorder with prior antiplatelet agents, such as aspirin, clopidogrel,
hospitalizations for a heroin overdose. He is on or dipyridamole. Data are limited to support the
Suboxone but is non-adherent. His blood use of cytotoxic drugs
pressure is 162/102 mmHg. Physical
examination is significant for scleral icterus, What is the prognosis of MPGN?- Complete
hepatomegaly, and palpable purpura. Serology or partial remission can be induced in secondary
shows decreased C3 and C4 levels and elevated MPGN by the treatment of the underlying
anti-hepatitis C antibodies. Urinalysis disease. In patients with idiopathic MPGN, 50%-
demonstrates dysmorphic red blood cells and red 60% will develop ESRD in 10-15 years if left
blood cell casts - Membranoproliferative untreated. How frequently does MPGN recur in
glomerulonephritis (MPGN) the transplanted kidney and what is the outcome
if it does? Type I and type III recur in ~30% of
What is the typical clinical presentation of transplants
MPGN?- Variable decrease in renal
function, HTN, anemia, hematuria, and A 15-year-old boy comes to the office because of
proteinuria malaise, anorexia, nausea, and decreased
2/8
