10. NephrItic Syndrome

Question 1

What is the clinical definition of Nephritic Syndrome?

Answer 1

Inflammation of the Glomerulus and characterised by

• High BP
• Mild Oedema
• Proteinuria (in dip)

Question 2

What two conditions can Nephritic Syndrome progress into?

Answer 2

1. Glomerulonephritis (Pathological Diagnosis)

2. Rapidly Progressive GN (Rapid fall in renal function)

Question 3

What is the clinical presentation of Early Glomerular Inflammation?

Answer 3

1. Urine dip Blood ++
2. Red cell casts on Urine Microscopy
3. Mild proteinuria

Question 4

What is the clinical presentation of Late Glomerular Inflammation?

Answer 4

1. Hypertension
2. Oedema
3. AKI

Question 5

What can you do after confirming protein and blood on a Urine dip?

Answer 5

If positive, send for Cytology for Red Cell casts

Send for Culture (rules out infection)

Question 6

What do Red Cell Casts on Urine microscopy mean?

Answer 6

Glomerulonephritis

Question 7

What are the most common forms of GN?

Answer 7

1. Autoimmune-mediated
2. Infection
3. Malignancies

Question 8

Give 5 examples of Immune-mediated GN

Answer 8

1. Small Vessel Vasculitis (ANCA-associated vasculitis)
2. SLE
3. Anti-GBM disease (Goodpastures)
4. IgA nephropathy (Berger’s Disease)
5. Cryoglobulinemia

Question 9

Give 5 examples of Infections that can cause GN

Answer 9

1. HepB
2. HepC
3. HIV
4. Post-streptococcal
5. Subacute Bacterial Endocarditis

Question 10

Give 2 examples of malignancies that can cause GN

Answer 10

Lymphoma

Multiple Myeloma

Question 11

*Describe the mechanism of Immunoglobulin mediated GN

Answer 11

1. Antibodies are deposited (IgA,Anti-GBM)
2. Complement is Activated
3. Chemokines released
4. Leukocytes recruited (LMN)
5. More chemokines/cytokiens released
6. Glomerular inflam/Necrosis/Crescent formation

Question 12

What signs and symptoms can a GN patient present with?

Answer 12

1. Generalised Weakness
2. Poor Appetite
3. Arthralgia (Neuralgic pain in joints)

Question 13

What can be the Differential Diagnoses for GN?

Answer 13

Infection

• Ruled out via Negative Urine+Blood culture
• Ruled out via Negative Sputum
• Ruled out by Normal CXR

Question 14

What can be screened for Nephritic Syndrome?

Answer 14

1. Complement C3/4)
2. Anti-streptolysin titre
3. IgG/M/A
4. ANA
5. Serum Electrophoresis
6. HepB, HepC, HIV
7. ANCA (+)
8. GBM Ab
9. Cryoglobulins

Question 15

What can be done for a suspected GN patient after screening blood?

Answer 15

1. Renal Biopsy for Crescentic Necrotising GN

Question 16

What is the ANCA test and how many types are there?

Answer 16

Antibody test that targets Neutrophils

There are two types

• Cytoplasmic: cANCA (PR3)
• Perinuclear: pANCA (MPO)

Question 17

What diseases are associated with positive ANCA results?

Answer 17

1. Small Vessel Vasculitis
   - Wegeners (cANCA)
   - Microscopic Polyangitis (pANCA)
   - Churg-Strauss
2. Drug-induced Vasculitis

Question 18

How can false positive ANCA results arise?

Answer 18

Infections and Endocarditis

Question 19

What other differential diagnoses can be associated with Low C3+C4 with Renal Disease?

Answer 19

1. SLE
2. Mesangiocapillary GN associated with HepC
3. Cryoglobulinemia
4. Post strep GN
5. IE
6. Foreign Bodies
7. Cholesterol Emboli