Glomerulonephritis Flashcards
What is nephritis?
Inflammation within the nephrons of the kidneys.
What does nephritis result in?
- Reduction in kidney function
- Haematuria: invisible or visible amounts of blood in the urine
- Proteinuria: less than in nephrotic syndrome
What are the most common types of nephritis in children?
- Post-streptococcal glomerulonephritis
* IgA nephropathy (Berger’s disease).
When does post streptococcal glomerulonephritis occur?
1 – 3 weeks after a β-haemolytic streptococcus infection
What is an example of a β-haemolytic streptococcus infection?
Tonsillitis
What is post streptococcal glomerulonephritis caused by?
Immune complex (IgG, IgM and C3) deposition in the glomeruli.
What immune complexes can be deposited in the glomeruli?
IgG
IgM
C3
What are the main features of post streptococcal glomerulonephritis?
General- Headache, Malaise visible haematuria proteinuria- this may result in oedema hypertension oliguria
What would you find in the blood of someone with post streptococcal glomerulonephritis?
Low C3
Raised ASO titre
How does post streptococcal glomerulonephritis appear on electron microscopy?
Subepithelial ‘humps’ caused by lumpy immune complex deposits
How does post streptococcal glomerulonephritis appear with immunofluorescence?
Granular or ‘starry sky’ appearance
What is there endothelial proliferation with in post streptococcal glomerulonephritis?
Endothelial proliferation with neutrophils
What is another name for IgA nephropathy?
Berger’s disease
What is IgA nephropathy the most common cause of?
The most common cause of glomerulonephritis worldwide
How does IgA nephropathy classically present?
It classically presents as macroscopic haematuria in young people following an upper respiratory tract infection.
What is IgA nephropathy associated with?
- coeliac disease/dermatitis herpetiformis
* Henoch-Schonlein purpura
What is IgA nephropathy caused by?
Mesangial deposition of IgA immune complexes
What would you find on the histology of someone with IgA nephropathy?
Mesangial hypercellularity
Positive immunofluorescence for IgA & C3
What is the typical presentation of a patient with IgA nephropathy?
- young male, recurrent episodes of macroscopic haematuria
- typically associated with a recent respiratory tract infection
- nephrotic range proteinuria is rare
- renal failure is unusual and seen in a minority of patients
What is the management of IgA nephropathy of there is isolated haematuria, no or minimal proteinuria (less than 500 to 1000 mg/day), and a normal glomerular filtration rate (GFR)?
No treatment needed, other than follow-up to check renal function
What is the management of persistent proteinuria (above 500 to 1000 mg/day), a normal or only slightly reduced GFR?
Initial treatment is with ACE inhibitors
What is the management if there is active disease (e.g. falling GFR) or failure to respond to ACE inhibitors?
Immunosuppression with corticosteroids
What is a possible complication of IgA nephropathy?
25% patients develop end stage renal failure
What indicates a good prognosis of IgA nephropathy?
Frank haematuria
What indicates a poor prognosis of IgA nephropathy?
Male gender Proteinuria (especially > 2 g/day) Hypertension Smoking Hyperlipidaemia ACE genotype DD
