Glomerulonephritis

Question 1

What conditions does the term ‘glomerulonephritis’ encompass?

Answer 1

• Caused by pathology in the glomerulus
• Present with proteinuria, haematuria, or both
• Are diagnosed on a renal biopsy
• Cause CKD
• Can progress to kidney failure

Question 2

The glomerulonephritides classically present on a spectrum ranging from nephrosis to nephritis. What’s the difference?

Answer 2

• Nephrosis → proteinuria due to podocyte pathology
• Nephritis → haematuria due to inflammatory damage

Question 3

Which investigations are done for glomerulonephritis?

Answer 3

• Urine → dipstick / MC+S / Bence-Jones protein
• Vitals → may be hypertensive
• Bloods → FBC / U+Es / LFT / CRP / Igs / Electrophoresis / Complement / Autoantibodies
• CXR → pulmonary haemorrhage
• Renal USS → size and anatomy for biopsy

Question 4

What is IgA nephropathy?

Answer 4

• Commonest primary GN in high-income countries
• Typically young adult with haematuria following an URTI
• Can be asympatomatic with non-visible haematuria
• May be hypertensive

Question 5

How is IgA nephropathy diagnosed?

Answer 5

Renal biopsy → IgA deposition in mesangium

Question 6

What is the treatment for IgA nephropathy?

Answer 6

• ACE-i / ARB reduce proteinuria and protect renal function
• Corticosteroids if persistent proteinuria >1g despite 3-6months of ACE-i/ARB and GFR > 50

Question 7

What are clinical features of HSP?

Answer 7

• Seen following infection
• Palpable purpuric rash (w/ localised oedema) over buttocks and extensors
• Abdo pain
• Polyarthritis
• Features of IgA nephropathy may occur (haematuria, renal failure)

Question 8

What is the treatment for HSP?

Answer 8

• Analgesia for arthralgia
• Treatment of nephropathy generally supportive

Question 9

What are features of post-streptococcal GN?

Answer 9

• Occurs after a throat (2ks) or skin (3-6wks) infection
• Streptococcal antigen deposits in the glomerulus leading to immune complex formation and inflammation
• Young children most commonly infected
• Presentation varies from haematuria to acute nephritis (haematuria, oedema, HTN)

Question 10

How is post-strep GN diagnosed?

Answer 10

• Increased ASO titre (Antistreptolysin O antibodies)
• Increased Anti-DNAse B
• Reduced C3

Question 11

How do you differentiate between IgA nephropathy and post-strep glomerulonephritis?

Answer 11

Question 12

What is the treatment for post-strep GN?

Answer 12

Supportive abx to clear nephritogenic bacteria

Question 13

What is anti-glomerular basement membrane (Anti-GMB) disease?

Answer 13

• Prev known as Goodpasture’s disease
• Rare
• Auto-antibodies to type IV collagen present in glomerular and alveolar basement membranes

Question 14

What is the clinical presentation of Anti-GBM disease?

Answer 14

• Renal → oliguria / haematuria / AKI / renal failure
• Lung → pulm haemorrhage / SoB / haemoptysis

Question 15

What is the treatment for Anti-GBM disease?

Answer 15

• Plasma exchange
• Corticosteroids
• Cyclophosphamide

Question 16

Rapidly progressive glomerulonephritis is any agressive GN, rapidly progressing to renal failure over days or weeks.

What are causes of rapidly progressive GN?

Answer 16

• Small vessel/ANCA vascuilitis
• Lupus nephritis
• Anti GBM disease

Question 17

How is rapidly progressive GN diagnosed?

Answer 17

Breaks in GBM allow an influx of inflammatory cells so that crescents are seen on renal biopsy

Question 18

What is the treatment for rapidly progressive GN?

Answer 18

• Corticosteroids
• Cyclophosphamide