Glomerulonephritis

Question 1

What is nephritis?

Answer 1

Inflammation within the nephrons of the kidneys.

Question 2

What does nephritis result in?

Answer 2

• Reduction in kidney function
• Haematuria: invisible or visible amounts of blood in the urine
• Proteinuria: less than in nephrotic syndrome

Question 3

What are the most common types of nephritis in children?

Answer 3

• Post-streptococcal glomerulonephritis

* IgA nephropathy (Berger’s disease).

Question 4

When does post streptococcal glomerulonephritis occur?

Answer 4

1 – 3 weeks after a β-haemolytic streptococcus infection

Question 5

What is an example of a β-haemolytic streptococcus infection?

Answer 5

Tonsillitis

Question 6

What is post streptococcal glomerulonephritis caused by?

Answer 6

Immune complex (IgG, IgM and C3) deposition in the glomeruli.

Question 7

What immune complexes can be deposited in the glomeruli?

Answer 7

IgG
IgM
C3

Question 8

What are the main features of post streptococcal glomerulonephritis?

Answer 8

General- Headache, Malaise
visible haematuria
proteinuria- this may result in oedema
hypertension
oliguria

Question 9

What would you find in the blood of someone with post streptococcal glomerulonephritis?

Answer 9

Low C3

Raised ASO titre

Question 10

How does post streptococcal glomerulonephritis appear on electron microscopy?

Answer 10

Subepithelial ‘humps’ caused by lumpy immune complex deposits

Question 11

How does post streptococcal glomerulonephritis appear with immunofluorescence?

Answer 11

Granular or ‘starry sky’ appearance

Question 12

What is there endothelial proliferation with in post streptococcal glomerulonephritis?

Answer 12

Endothelial proliferation with neutrophils

Question 13

What is another name for IgA nephropathy?

Answer 13

Berger’s disease

Question 14

What is IgA nephropathy the most common cause of?

Answer 14

The most common cause of glomerulonephritis worldwide

Question 15

How does IgA nephropathy classically present?

Answer 15

It classically presents as macroscopic haematuria in young people following an upper respiratory tract infection.

Question 16

What is IgA nephropathy associated with?

Answer 16

• coeliac disease/dermatitis herpetiformis

* Henoch-Schonlein purpura

Question 17

What is IgA nephropathy caused by?

Answer 17

Mesangial deposition of IgA immune complexes

Question 18

What would you find on the histology of someone with IgA nephropathy?

Answer 18

Mesangial hypercellularity

Positive immunofluorescence for IgA & C3

Question 19

What is the typical presentation of a patient with IgA nephropathy?

Answer 19

• 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

Question 20

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)?

Answer 20

No treatment needed, other than follow-up to check renal function

Question 21

What is the management of persistent proteinuria (above 500 to 1000 mg/day), a normal or only slightly reduced GFR?

Answer 21

Initial treatment is with ACE inhibitors

Question 22

What is the management if there is active disease (e.g. falling GFR) or failure to respond to ACE inhibitors?

Answer 22

Immunosuppression with corticosteroids

Question 23

What is a possible complication of IgA nephropathy?

Answer 23

25% patients develop end stage renal failure

Question 24

What indicates a good prognosis of IgA nephropathy?

Answer 24

Frank haematuria

Question 25

What indicates a poor prognosis of IgA nephropathy?

Answer 25

Male gender
Proteinuria (especially > 2 g/day)
Hypertension
Smoking
Hyperlipidaemia
ACE genotype DD