Glomerulonephritis

Question 1

Features

Answer 1

Group of disorders resulting from glomerular damage
Can → proteinuria ± haematuria
Can → AKI or ESRF

Question 2

Presentations (3)

Answer 2

Asymptomatic haematuria
Nephrotic syndrome
Nephritic syndrome

Question 3

Causes

Answer 3

Idiopathic
  Immune: SLE, Goodpastures, vasculitis
  Infection: HBV, HCV, Strep, HIV
  Drugs: penicillamine, gold
  Amyloid

Question 4

Investigations - bloods

Answer 4

Basic: FBC, U+E, ESR
  Complement (C3 and C4)
  Abs: ANA, dsDNA, ANCA, GBM
  Serum protein electrophoresis and Ig
  Infection: ASOT, HBC and HCV serology

Question 5

Investigations - urine

Answer 5

Dipstick: proteinuria ± haematuria
Spot PCR
MCS
Bence-Jones protein

Question 6

Investigations - imaging

Answer 6

CXR: infiltrates (Goodpasture’s, Wegener’s)

Renal US ± biopsy

Question 7

General management

Answer 7

General Mx
Refer to nephrologist
Rx HTN aggressively ( 130/80)
Include and ACEi / ARA

Question 8

Causes of asymptomatic haematuria

Answer 8

1. IgA Nephropathy 2. Thin BM

3. Alport’s

Question 9

Features of IgA nephropathy (Berger’s disease)

Answer 9

Young male ̄c episodic macroscopic haematuria occurring a few days after URTI.
Rapid recovery between attacks
↑IgA
Can occasionally → nephritic syndrome

Question 10

IgA nephropathy biopsy, treatment and prognosis?

Answer 10

IgA deposition in mesangium
Steroids or cyclophosphamide if ↓renal function
20% ESRF after 20yrs

Question 11

Features of thin BM disease

Answer 11

Autosomal dominant

Persistent, asymptomatic microscopic haematuria V. small risk of ESRF

Question 12

Alport’s syndrome features

Answer 12

85% X-linked inheritance
  Haematuria, proteinuria   progressive renal failure
  Sensorineural deafness
  Lens dislocation and cataracts
  Retinal “flecks”
  Females: haematuria only