Glomerulonephritides

Question 1

Nephritic Syndrome

What does it refer to?

What are the features of nephritic syndrome?

Causes

Answer 1

Nephritic syndrome or acute nephritic syndrome refers to a group of symptoms, not a diagnosis. When we say a patient has “nephritic syndrome” it simply means they fit a clinical picture of having inflammation of their kidney and it does not represent a specific diagnosis or give the underlying cause.

Unlike nephrotic syndrome, there are no set criteria, however there are the following features in nephritic syndrome:

• Haematuria: microscopic (not visible) or macroscopic (visible) - red cell casts
• Oliguria means there is a significantly reduced urine output.
• Proteinuria is protein in the urine. In nephritic syndrome there is less than 3g / 24 hours. Any more and it starts being classified as nephrotic syndrome.
• Fluid retention (flash pulmonary oedema)

Causes:

• Vasculitides
• Rapidly Progressive GN
• IgA Nephropathy (fewer letters so only 2-3 days after throat infection)
• Alport syndrome
• Anti-GBM - local renal disease, if systemic with lungs = Goodpasture

Question 2

Nephrotic Syndrome

What is it?

What is the criteria the patient must fulfil?

Causes

Answer 2

Nephrotic syndrome refers to a group of symptoms without specifying the underlying cause. Therefore nephrotic syndrome is not a disease, but is a way of saying “the patient has these symptoms”, which indicates there is an underlying disease present but doesn’t specify the disease.

To have nephrotic syndrome a patient must fulfil the following criteria:

• Peripheral oedema
• Proteinuria more than 3g / 24 hours
• Serum albumin less than 25g / L
• Hypercholesterolaemia

Causes: [Me Me Mi FSGS SAD]
Membranous
Mesangiocapillary
Miminal Change

FSGS

SLE (inflammation)
Amyloidosis (abnormal protein)
DM

Question 3

What does nephrotic syndrome predispose patients to?

Answer 3

• thrombosis
• hypertension
• high cholesterol

Question 4

What is the most common cause of nephrotic syndrome in children?

Cause
Treatment

Answer 4

Minimal change disease

• histology: nothing
• microscopy: podocyte effacement

Idiopathic (no identified cause)

Treated successfully with steroids
(and fluid and salt restriction)

Question 5

What is the most common cause of nephrotic syndrome in adults?

Answer 5

Focal segmental glomerulosclerosis.

Question 6

IgA nephropathy (AKA Berger’s disease or mesangioproliferative glomerulonephritis)

Peak Age
Clinical Feature
When does it occur?

What does histology show?

Answer 6

Most common cause of primary glomerulonephritis (not caused by another disease)

Peak age at presentation is in the 20s
Clinical Features: Nephritic syndrome (haematuria, proteinuria <3g, oliguria, fluid retention)

Occurs: 2-3 days within an upper resp tract infection

Histology shows “IgA deposits and glomerular mesangial proliferation”

Question 7

Membranous glomerulonephritis

Peak age
Causes

What does histology show?

Answer 7

There is a bimodal peak in age in the 20s and 60s.

CAUSE

• The majority (~70%) are idiopathic
• Can be secondary to SLE, rheumatoid disorders and drugs (e.g. NSAIDS, pencillamine in Wilson’s)

Histology shows “IgG and complement deposits on the basement membrane/ under the”

Question 8

Post streptococcal glomerulonephritis (AKA diffuse proliferative glomerulonephritis)

Peak Age
When does it occur?

Clinical Features

Management

Answer 8

Patients are typically under 30 years. It presents as:

1-6 weeks after a streptococcal infection (e.g. tonsillitis or impetigo)

Clinical features: nephritic syndrome [haematuria, oliguria, proteinuria <3g, peripheral oedema]

Management:
- Usually self resolving so supportive

Question 9

Goodpasture syndrome

Pathology

Clinical features

Answer 9

PATHOLOGY
- Anti-GBM (glomerular basement membrane) antibodies attack glomerulus and pulmonary basement membranes.

CLINICAL FEATURES

• glomerulonephritis / AKI
• pulmonary haemorrhage / haemoptysis (coughing up blood)

Question 10

Rapidly progressive glomerulonephritis

What does histology show?

What syndrome does it cause

Cause

Answer 10

Histology shows “crescentic glomerulonephritis”

Clinical features: Nephritic syndrome

Often secondary to Goodpasture syndrome

Question 11

What are most types of glomerulonephritis treated with?

Answer 11

Immunosuppression (e.g. steroids)

Blood pressure control by blocking renin-angiotensin system (i.e. ACEi or ARBs)

Question 12

What is glomerulonephritides

Answer 12

Inflammation of apparatus that filtrates blood

Question 13

FSGS

What syndrome does it cause

Cause
Histology
Management

Answer 13

Nephrotic syndrome

Cause: HIV

Histology: sclerosis on light microscopy

Management: steroids

Question 14

Mesangiocapoliary / mEMBRANOPROLIFERATIVE

CF

Ca

Answer 14

CF: nephritic and nephrotic