Glomerulonephritis

Question 1

Define glomerulonephritis

Answer 1

Immune-mediated inflammation and injury of the renal glomeruli
e.g. antigen-antibody immune complex deposition in glomeruli -> inflammation,
complement activation and coagulation cascades

Nephrotic:
• Minimal change disease
• Focal segmental glomerulosclerosis
• Membranous nephropathy

Nephritic:
• IgA nephropathy (Berger’s disease)
o 1-2 days after URT, GI or urinary tract infection
o IgA mediated immune complex deposition
• Post-infectious glomerulonephritis
o 1-3 weeks after Strep throat infection
o Complement mediated immune complex deposition (IgG and C3)
• Goodpasture’s syndrome
o Anti-GBM antibodies (type IV collagen)
o Linear deposition of IgG in GBM
o May have lung involvement
• Vasculitides

Question 2

What are the causes/risk factors of glomerulonephritis?

Answer 2

• Idiopathic
• Infection e.g. group A beta-haemolytic streptococci, Streptococcus viridans,
Staphylococci, gonococci, Salmonella, syphilis, hepatitis B/C, HIV, schistosomiasis
• Systemic inflammatory diseases e.g. SLE, vasculitides
• Drugs e.g. gold, penicillamine, NSAIDs
• Metabolic e.g. diabetes mellitus
• Malignancy e.g. lung cancer, colorectal cancer, lymphoma
• Hereditary e.g. Alport’s syndrome

Question 3

What are the symptoms of glomerulonephritis?

Answer 3

• Haematuria
• Swelling
• Polyuria/oliguria

Symptoms of uraemia
• Anorexia
• Nausea

Question 4

What are the signs of glomerulonephritis?

Answer 4

• Haematuria (microscopic or
macroscopic)
• Red cell casts
• Proteinuria
• Oedema
• Oliguria
• Hypertension (↓GFR and salt and
water retention)
• Uraemia

Question 5

What investigations are carried out for glomerulonephritis?

Answer 5

• FBC - normochromic Normocytic Anaemia (ACD).
• U&Es - hyponatraemia; hyperkalaemia; elevated Urea and Creatinine.
• ESR/ CRP - elevated in inflammatory aetiologies.
• eGFR - normal or reduced, depending on progression to RF.
• LFTs - low Albumin.
- Hepatitic picture if viral hepatitis is suspected; elevated ALT.
• Complement - elevated in immunological/ inflammatory causes.
• Serology - ANA,
Anti-dsDNA Antibodies,
ANCA, Anti-GBM Antibodies, Cryoglobulins if appropriate
• Urinalysis - haematuria, proteinuria, dysmorphic RBCs, leukocytes, and RBC casts.
• 24-hour urine - proteinuria
• Renal Biopsy - light microscopy, electron microscopy, immunofluorescence microscopy. Allows for the pathological diagnoses.
• Cause - antibodies, electrophoresis for myeloma, hepatits serology, PCR, blood cultures, drug screen, CT scans etc…