Glomerulonephritis

Question 1

What is glomerulonephritis?

Answer 1

Glomerulonephritis is a term for inflammation within the glomerulus and nephrons in the kidney.

Disorders are often immune mediated.

They can be primary (no systemic cause) or secondary to another condition (SLE)

Question 2

What clinical syndromes do glomerulonephritis cause?

Answer 2

Can cause both nephrotic and nephritic syndrome.

Question 3

Outline the clinical features of nephrotic and nephritic syndrome?

Answer 3

NephrOtic:

• Proteinuria
• Hypoalbuminaemia
• Oedema
• Hyperlipidaemia

Nephritic:

• Proteniuria and haematauria
• HTN
• Oliguria (reduced GFR)

(although not technically part of the clinical picture may be some oedema due to the decline in GFR)

Question 4

How can glomerulonephritis present?

Answer 4

It can present as asymptomatic haematuria/proteinuria.

May present with the symptoms of nephrotic or nephritic syndrome.

Rapidly progressing glomerulonephritis can lead to rapidly declining renal function resulting in end astute renal failure.

Question 5

What is the most common cause of a glomerulonephritis in children?

Answer 5

Post-streptococcal glomerulonephritis – appears weeks after upper respiratory tract infection (URTI) (most common)

Other causes:

• IgA nephropathy – appears within a day or two after a URTI
• Vasculitis (HSP/SLE/Wegner’s granulomatosis)

Question 6

How would you investigate a child with suspected glomerulonephritis?

Answer 6

Bedside:

• BP
• Urinalysis

Bloods + Cultures:

• Urine culture (rule out infection)
• U/e’s
• FBC (infection)
• LFT’s (albumin)
• Lupus serology

Imaging:
Renal US (used to rule out other causes of haematuria and HTN such as renal aa stenosis)

Biopsy:
Renal Biopsy (not necessary in nephrotic syndrome in children or if case is mild)

Question 7

What is the management of glomerulonephritis in children?

Answer 7

Manage cause + supportive treatment for: HTN, fluid/electrolyte abnormalities.

For post strep-glomerulonephritis: self limiting so just supportive measures.

For vasculitis: immunosuppressive medication may be indicated.

HTN: treat with antihypertensive’s ACEi

Fluid/electrolyte: usually hypervolaemic treat with fluid restriction + diuretics.