8. Glomerulonephritis

Question 1

What is glomerulonephritis?

Answer 1

Spectrums ranging from nephrosis (protein leakage) to nephritis (inflammation)

Most lead to CKD

Question 2

How are the glomerulonephritis’ diagnosed?

What is the procedure?

Answer 2

Renal biopsy

Blood pressure below 160/95, heamaglobin>90

Question 3

What are the nephritis’?

Answer 3

IgA nephropathy- common
Henoch-Schonlen purpura-IgA deposition in vessels (vasculitis)
Post-streptococcal glomerulonephritis- (throat/skin primary)
Anti-glomerular basement membrane-
Rapidly progressing GN

Question 4

How does IgA nephropathy present?

Answer 4

Asymptomatic non visible haematuria or episodic hematuria that may coincide with a throat infection

Slow disease which progresses over 30 years

Question 5

How does IgA nephropathy get treated?

Answer 5

ACE-I/ARB to keep proteinurua <1g

Corticosteroids and fish oil if persistent proteinuria for 3-6 months

Question 6

How does henoch schonlein purpura present?

Answer 6

Purpuric rashes of extensor surfaces,
polyarthritis,
abdominal pain,
nephritis.

Question 7

How is HSP treated?

Answer 7

ACE-I/ARB to keep proteinurua <1g

Corticosteroids and fish oil if persistent proteinuria for 3-6 months

Steroids for gut manifestating

Question 8

How does post streptococcal GN present?

Answer 8

Hematuria/acute nephritis, oedema, raised BP and oliguria typically 2 weeks after throat or 3-6 weeks after skin infection

Question 9

How do you diagnose post streptococcal GN?

How is it treated?

Answer 9

Evidence of a strep infection, ASOT, anti-DNAase, educed C3

Support kidney function, antibiotics to clear nephritogenic bacteria

Question 10

How does anti glomerular basement membrane present?

Answer 10

renal and lung disease/ Dialysis dependent on presentation

Question 11

How do you treat anti-GMB disease?

Answer 11

plasma exchange
Corticosteroids
Cyclophosphamide (immune suppression)H

Question 12

What is rapidly progressive Glomerulonephritis?

How is it treated?

Answer 12

Aggressive glomerulonephritis progressing to renal failure over days or weeks. Usually due to a secondary cause

Corticosteroids
Cyclophosphamide
Treatment of secondary disease

Question 13

How does nephrotic syndrome present?

Answer 13

Generalized pitting oedema

Question 14

How is nephrotic syndrome treated?

Answer 14

Reduce oedema (<1L and salt restriction). Aim for 0.5-1kg weight loss per day. Use loop diuretic

Treat underlying cause- renal biopsy,give treatment specific to disease

Reduce proteinuria- ace I/ ARB (may not be needed in MCD)

Question 15

What are the complications of nephrotic syndrome?

Answer 15

Thromboembolism- hypercoagulable due to increased clotting factors and reduced anti-thrombin and platelets

Infection- loss of immunoglobulins and immune mediators lead to increased infection

Hyperlipideamia- due to hepatic synthesis in response to reduced oncotic pressure

Question 16

What are the different nephrotic syndromes?

Answer 16

Minimal change disease- most common, idiopathic/drugs/neoplasm

Focal segmental glomerulosclerosis- primary/secondary

membranous nephropathy-

Membranoproliferative glomerulonephritis-immune complex associated/ C3 glomerulopathy

Question 17

How do you treat minimal change disease?

Answer 17

Prednisolone 1mg/Kg

Relapses are managed with longer term immunosuppression

Question 18

How do you treat focal segmental glomeruloscleorsis?

Answer 18

Corticosteroids only in idiopathic disease

Calcineurin inhibitors may be considered second line

Question 19

How do you treat membranous nephropathy?

Answer 19

immunosuppression in those with proteinuria>4g

Question 20

How do you treat membranoproliferative glomerulonephritis?

Answer 20

Treat underlying cause in immune complex disease

Trial immune suppression if no underlying cause found