Glomerulonephritis

Question 1

What is Glomerulonephritis?

Answer 1

=> Encompasses a number of conditions which:

• Are caused by pathology in the glomerulus
• Present with proteinuria, haematuria or both
• Causes CKS
• Cause AKI

Question 2

What are the 2 syndromes in Glomerulonephritis?

Answer 2

• Nephritic syndrome

- Nephrotic syndrome

Question 3

What is Nephrotic syndrome and what are the different conditions that can lead to it?

Answer 3

=> Triad of:

• Proteinuria > 3g/24h
• Hypoalbuminaemia
• Oedema

=> Conditions:

• Minimal change disease
• Focal segmental glomerulosclerosis
• Membranoproliferative glomerulonephritis

Question 4

What is the management of Nephrotic syndrome?

Answer 4

=> Reduce oedema:

• Fluid and salt restriction
• Diuretics

=> Treat underlying cause

=> Reduce proteinuria:
- ACEi or ARBs

=> Treat complications:

• Hyper-coaguable state as liver tries to compensate for the loss of albumin by increasing activity (more clotting factors). So give anti platelet therapy
• Give pneumococcal vaccine as antibodies are lost through kidneys
• Statins due to excess cholesterol production again due to liver

Question 5

What is minimal change disease, causes, diagnosis and treatment?

Answer 5

• Seen in children
• Sees minimal change on renal biopsy, but under electron microscope you see effacement of podocyte

=> Treatment:
- Predinisolone

Question 6

What is membranous glomerulonephritis, causes, diagnosis and treatment?

Answer 6

• Membranous Glomerulonephritis involves the deposition of immune complexes in the glomerulus
• Can also occur as a result of genetic or acquired defects in the alternative complement pathway

=> Diagnosis:
- Electron microscopy

=> Treatment:
- ACEi or ARBs for blood pressure control

Question 7

What is Focal segmental glomerulosclerosis causes, diagnosis and treatment?

Answer 7

• Sclerosis seen on renal biopsy as a result of drugs or other disease

=> Treatment:
- ACEi or ARBs to control BP

Question 8

What is Nephritic syndrome and what are the different conditions that can lead to it?

Answer 8

=> Features:

• Haematuria
• Hypertension

=> Conditions:

• IgA nephropathy
• Rapidly progressive glomerulonephritis
• Post streptococcal infection

Question 9

What is IgA nephropathy (Bergers disease) causes, diagnosis and treatment?

Answer 9

• Occurs as a result of mesangial deposition of IgA immune complexes
• Presents as macroscopic haematuria after a URTI 2 days prior

=> Diagnosis:
- Positive immunofluorescence for IgA and C3

=> Treatment:

• ACEi and ARB to control any proteinuria if present
• Immunosuppression not shown to be useful

Question 10

What is Post streptococcal infection, causes, diagnosis and treatment?

Answer 10

• Caused by immune complex deposition
• Occurs 7-14 days after a streptococcal infection

=> Diagnosis:
- Evidence of infection: increased anti-dsDNA, low C3

=> Treatment:
- Antibiotics

Question 11

What is the difference between IgA nephropathy and Post-Streptococcal infection?

Answer 11

• Post Streptococcal infection associated with low C3
• Main symptom in streptococcal is proteinuria
• Interval between URTI and renal problems in Post streptococcal

Question 12

What is rapidly progressive glomerulonephritis, causes and treatment?

Answer 12

• Term used for rapidly declining renal function associated with formation of renal crescents in the glomerulus

=> Causes:

• Good pasture’s syndrome
• Wegeners granulomatosis
• SLE

=> Treatment:
- Corticosteroids and cyclophophamide