Glomerulonephritis

Question 1

What is this a presentation of?

Significant proteinuria, hypoalbuminaemia, oedema, hyperlipidaemia.

Answer 1

Nephrotic syndrome

Question 2

What is this a presentation of?

Haematuria (dysmorphic RBC and casts), small amounts of proteinuria, low urine volume = low eGFR, mild HTN.

Answer 2

Nephritic syndrome

Question 3

What is the aetiology of nephrotic and nephritic syndrome?

Answer 3

1. Nephrotic - proteinuria due to podocyte damage

2. Nephritic - haematuria due to inflammatory change

Question 4

What is this describing and how is it treated?

1. Commonest primary glomerulonephritis in high income countries.
2. 20-30% progress to ESRF over 30 years.
3. Asymptomatic, haematuria after URTI.
4. Biopsy diagnosis

Answer 4

1. IgA nephropathy

2. ACEi/ARB, steroids and fish oil if proteinuria despite ACEi for 6 months.

Question 5

What is this describing and how is it treated?

1. Small vessel vasculitis and systemic variant of IgA nephropathy.
2. Purpuric rash on extensor surfaces, polyarthritis, abdominal pain and nephritis.
3. Clinical diagnosis, biopsy identical to IgA nephropathy.

Answer 5

1. Henoch-Schoenlein purpura

2. ACEi/ARB, steroids and fish oil if proteinuria despite ACEi for 6 months.

Question 6

What is this describing and how is it treated?

1. Occurs after throat or skin infection
2. Ags deposit in glomerulus leading to immune complex formation and inflammation.
3. From haematuria to acute nephritis

Answer 6

1. Post-streptococcus glomerulonephritis

2. Supportive treatment with antibiotics to clear bacteria.

Question 7

What is this describing and how is it treated?

1. Rare, autoantibodies to type IV collagen in glomerular and alveolar basement membranes.
2. Rapidly progressive (weeks-months)
3. Renal and lung disease

Answer 7

1. Anti-glomerular basement membrane disease (anti-GBM) or Goodpasture’s disease.
2. Plasma exchange, steroids and cyclophosphamide.