Glomerulonephritis

Question 1

Define glomerulonephitis

Answer 1

glomerular injury characterised by inflammatory changes (not always)

applies to a group of diseases

The inflammatory changes are mostly immune mediated.

Question 2

What conditions/diseases come under the glomerulonephritis?

Answer 2

Diseases include;
membranous GN, 
minimal change disease,
focal and segmental glomerulosclerosis, 
immunoglobulin A nephropathy,
forms of rapidly progressive GN (vasculitis and anti-GBM disease),
SLE nephritis 

glomerular damage in other systemic diseases such as diabetes, amyloidosis, myeloma, and a variety of infections.

Read laz for classification

Question 3

Risk factors of glomerulonephritis

Answer 3

Drugs - NSAIDs, cocaine, captopril, anabolic steroids

Group A Beta haemolytic Strep - i.e. pharyngitis
Respiratory & GI infections

Hep B, Hep C
HIV
Infective endocarditis - s.aureus, s.viridans

(Non) Hodgkin’s lymphoma

Colorectal cancer
Lung cancer
Leukaemi and other cancers

Question 4

Presenting symptoms of glomerulonephritis?

Answer 4

Oliguria - if renal failure
Nausea
Weight loss
Anorexia
Fever
Malaise
  in vasculitic causes;
Rash - possible purpura (henoch schonlein) - v
arthralgia

Related to strep infection;
Sore throat; 1-2 wks before renal symptoms
Abdominal pain; post strep infection

Hypervolaemia - oliguria, oedema, SOB

Signs of uraemia

Question 5

Signs of uraemia?

Answer 5

progressive weakness and easy fatigue,

loss of appetite due to nausea and vomiting,

muscle atrophy, tremors,

abnormal mental function, frequent shallow respiration and metabolic acidosis.

Without intervention via dialysis or kidney transplant, uremia due to renal failure will progress and cause stupor, coma and death

Question 6

Signs of glomerulonephritis on investigation?

Answer 6

Hypertension

Proteinuria

Haematuria (especially in IgA nephropathy)

Renal failure

Nephrotic syndrome triad

Nephritic syndrome

Question 7

Define nephrotic syndrome?

Answer 7

TRIAD of:

Proteinuria > 3.5 g/24 hrs

Low serum albumin < 24 g/L

Oedema

NOTE: due to the hypoalbuminaema, the liver tries to compensate and increases production of lipids, causing hyperlipidaemia

Question 8

What is nephritic syndrome

Answer 8

hypertension + proteinuria + haematuria)

Syndrome comprising of signs of nephritis

Pores in the podocytes are large enough to allow protein AND red blood cells to pass into the urine

MAIN FEATURE: Haematuria

This is in contrast to nephrotic syndrome, which is mainly concerned with proteinuria

There may also be red cell casts in the urine - indicative of glomerular damage

Other features:

Proteinuria

Hypertension

Low urine output (due to decreased renal function)

NOTE: in nephrotic syndrome, only PROTEINS are moving into the urine

Question 9

Investigations to order for glomeulonepritis?

Answer 9

Urinalysis - haematuria, proteinuria, dysmorphic RBCs, leukocytes, and RBC casts

Renal biopsy - urgent if glomeruloneprhitis suspected

LFTs;
normal or renal failure, (high creatinine)
elevated liver enzymes, hypoalbuminaemia

GFR - normal or reduced

FBC - normocytic Anaemia is a feature of several systemic diseases that are associated with GN.

Lipids - hyperlipidaemia or normal

Urine ACR; If ACR is >220 mg/mmol, patients are classified as having nephrotic-range proteinuria . better than 24 hour urine - can be done too

US kidenys - small or normal

ACR - albumin creatinine ratio

Theres many more tests