Glomerulonephritis

Question 1

Define Glomerulonephritis

Answer 1

Glomerular injury, usually characterised by inflammatory changes in the glomerular capillaries and basement membrane, often immunologically mediated

(Inflammation of the glomerulus that leads to nephrotic and nephritic syndromes)

Question 2

Aetiology of Glomerulonephritis

Answer 2

Leukocyte infiltration, antibody deposition and complement activation

Commonly Idiopathic
Infection: group A beta-haemolytic Strep, resp and gastro infections, hep B/C
Vasculitides: SLE, RA, granulomatosis polyangiitis, scleroderma, HUS
Drugs: penicillamine, NSAIDs, heroin, mitomycin C, cocaine, gold
Metabolic: DM, HTN, thyroititis
Malignancy: lung and colorectal cancer, melanoma, Hodgkin’s
Hereditary: Fabry’s, Alport’s, thin BM disease
Deposition: amyloidosis, light chain deposition

Question 3

What are the types of nephrotic syndrome

Answer 3

Deposition diseases
Minimal change disease
Focal and segmental glomerulosclerosis
Membranous nephropathy
Membranoproliferative GN

Question 4

What are the types of nephritic syndrome

Answer 4

IgA nephropathy
Postinfectious GN
Rapidly progressive GN (Vasculitis | Anti-glomerular basement membrane (GBM) GN)

Question 5

Symptoms of glomerulonephritis

Answer 5

Swelling: periorbital, peripheral (more common in nephrotic syndromes)
Oliguria, polyuria
Anorexia
Malaise, weight loss, fever (infectious)
Nausea
Skin rash 
Arthralgia 
Haemoptysis 
Abdominal pain
Sore throat 
Symptoms of fluid overload due to reduced urinary output e.g. SOB, oedema

Hx of recent infection

Question 6

Features of nephrotic syndrome

Answer 6

Proteinuria
Hypoalbuminaemia
Oedema (facial in kids, peripheral in adults)
(hyperlipidaemia)

Question 7

Features of nephritic syndrome

Answer 7

Haematuria (coca-cola coloured urine)
Red cell clasts in urine
Proteinuria (< than nephrotic)
uraemia
Oliguria
Hypertension

Question 8

Describe Post-streptococcal glomerulonephritis and findings on investigations

Answer 8

1-3 weeks following group A beta-haemolytic streptococci infections (sore throat, impetigo)

Haematuria, proteinuria, oedema, HTN

+ve anti-strep antibodies

Question 9

Describe IgA nephropathy (Berger’s disease)

Answer 9

1-2 days post URTI

Persistent or recurrent frank haematuria
Asymptomatic microscopic haematuria

High IgA
Macroscopic haematuria

Question 10

Describe Rapidly progressive glomerulonephritis

Answer 10

Nephritic syndrome symptoms
Oliguria and renal failure more pronounced

Vasculitis
Lupus nephritis (SLE)
Anti-GBM disease (Goodpasture’s)

Vasculitis: pANCA/cANCA
Lupus nephritis: dsDNA
Anti-GBM disease (Goodpasture’s): Anti-GBM antibodies

Question 11

Investigations Glomerulonephritis

Answer 11

Urinalysis and microscopy: haematuria, proteinuria, dysmorphic RBCs, leukocytes, RBC clasts

Metabolic profile: normal or renal failure
GFR: normal or reduced
FBC: normocytic normochromic anaemia
Lipid: hyperlipidaemia or normal

USS kidneys: small or normal (exclude other pathology)
ESR/CRP: Elevated or normal