I n t e r n a L medicine questions Bank

IgA nephropathy

Basics

• 
  also caused Berger's disease or mesangioproliferative glomerulonephritis
  
• 
  commonest cause of glomerulonephritis worldwide
  
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  pathogenesis unknown, ?mesangial deposition of IgA immune complexes
  
• 
  histology: mesangial hypercellularity, positive immunofluorescence for IgA & C3
  

Differentiating between IgA nephropathy and post-streptococcal glomerulonephritis

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  post-streptococcal glomerulonephritis is associated with low complement levels
  
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  main symptom in post-streptococcal glomerulonephritis is proteinuria (although haematuria can occur)
  
• 
  there is typically an interval between URTI and the onset of renal problems in post-streptococcal glomerulonephritis
  

Presentations

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  young male, recurrent episodes of macroscopic haematuria
  
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  typically associated with mucosal infections e.g., URTI
  
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  nephrotic syndrome
  
• 
  renal failure
  

Associated conditions

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  alcoholic cirrhosis
  
• 
  coeliac disease/dermatitis herpetiformis
  

Management

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  steroids/immunosuppressants not be shown to be useful
  

Prognosis

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  25% of patients develop ESRF
  

Which one of the following would have been most likely to prevent the deterioration in renal function?

	A.	Low dose dopamine
	B.	Urinary acidification
	C.	Intravenous fluids
	D.	Frusemide
	E.	Mannitol
Collapse + ARF --> rhabdomyolysis - treat with IV fluids

Intravenous fluids are the most important management step in the prevent of rhabdomyolysis in such patients