Glomerulonephritis

Question 1

What is glomerulonephritis?

Answer 1

immunologically mediated inflammation of the renal glomeruli
Many different types with different aetiologies

Question 2

Describe the aetiology of glomerulonephritis

Answer 2

Some types caused by deposition of antibody-antigen complexes in glomeruli: causes inflammation + complement activation.
Antigens to which antibodies are produced are UNKNOWN
Causes are usually considered primary (idiopathic) or secondary (to infection, AI, malignancy) + tend to present with similar syndromes

Question 3

Describe the epidemiology of glomerulonephritis

Answer 3

25% of chronic renal failure cases

Question 4

List 3 presenting features of glomerulonephritis

Answer 4

Polyuria or oliguria
Hx of recent infection (fever, sore throat, abdo pain)
Sx of uraemia or renal failure (acute + chronic)

Question 5

List 5 signs of glomerulonephritis

Answer 5

HTN
Proteinuria  
Haematuria (esp. in IgA nephropathy) 
Renal failure  
Nephrotic syndrome or Nephritic syndrome

Question 6

What triad characterises nephrotic syndrome?

Answer 6

Proteinuria > 3.5 g/24 hrs
Low serum albumin < 24 g/L
Oedema

Question 7

What is nephritic syndrome?

Answer 7

Pores in podocytes are large enough to allow protein + RBCs to pass into urine
May also be red cell casts in the urine: indicative of glomerular damage
Other features:
Proteinuria
HTN
Low urine output (due to decreased renal function)

Question 8

How can nephrotic syndrome lead to hyperlipidaemia?

Answer 8

due to the hypoalbuminaema, the liver tries to compensate + increases production of lipids, causing hyperlipidaemia

Question 9

What bloods are tested in glomerulonephritis?

Answer 9

FBC: normocytic, normochromic anaemia
U+Es + creatinine (GFR is more accurate than serum creatinine alone)
LFTs (check albumin + whether liver enzymes are elvevated)
Lipid profile (for hyperlipidaemia)
Complement studies
Antibodies

Question 10

What antibodies are checked for in glomerulonephritis?

Answer 10

ANA (SLE)
Anti-dsDNA (SLE)
ANCA 
Anti-GBM antibody 
Cryoglobulins

Question 11

What tests are used to investigate urine in glomerulonephritis?

Answer 11

Microscopy: check for red cell casts

24 hr collection: creatinine clearance + protein

Question 12

What other investigations are performed in glomerulonephritis?

Answer 12

Renal tract US to exclude other pathology (e.g. obstruction)
Renal Biopsy: For microscopy + determines sub-type
Ix for associated conditions (e.g. HBV, HCV + HIV serology)

Question 13

List types of glomerulonephritis

Answer 13

Minimal-change Glomerulonephritis
Membranous Glomerulonephritis
Membranoproliferative Glomerulonephritis (MPGN)
Focal segmental glomerulosclerosis
Focal segmental proliferative glomerulonephritis
Diffuse proliferative glomerulonephritis
Crescentic Glomerulonephritis
Focal Segmental Necrotising Glomerulonephritis

Question 14

Describe Minimal-change Glomerulonephritis

Answer 14

Light microscopy: minimal change

Electron microscopy: loss of epithelial foot process

Question 15

What may the antigens to which the antibodies are produced against associated with?

Answer 15

Bacteria (e.g. Strep. viridans, Staphylococci)
Viruses (e.g. HBV, HCB, measles, mumps, EBV)
Protozoal (e.g. Plasmodium malariae, schistosomiasis)
Inflammatory diseases (e.g. SLE, vasculitis, cryoglobulinaemia)
Drugs (e.g. gold, penicillinamine)
Metabolic disorders (e.g. DM, HT, thytoiditis)
Deposition diseases (e.g. amyloidosis)
Malignancy/Tumour

Question 16

How do patients with glomerulonephritis present?

Answer 16

Patients present with specific syndromes: either NEPHROTIC or NEPHRITIC

Question 17

What is nephrotic syndrome?

Answer 17

increased permeability of the glomerulus leading to loss of proteins into the tubules
LOSS OF A LOT OF PROTEIN

Question 18

List 5 symptoms caused by general vasculitic effects in glomerulonephritis

Answer 18

Anorexia
Nausea
Malaise
Skin rash (purpura)
Arthralgia

Question 19

What triad characterises nephritic syndrome?

Answer 19

Haematuria
Proteinuria
HTN

Question 20

What is good pastures syndrome? Give 3 features

Answer 20

Crescentic Glomerulonephritis with anti-glomerular basement membrane antibodies + anti-alveolar membrane antibodies
Glomerulonephritis, pulmonary haemorrhage + haemoptysis