Glomerulonephritis

Question 1

What is Glomerulonephritis?

Answer 1

Damage to the Glomeruli, mostly due to immune-mediated processes.

Question 2

What is Nephritic Syndrome + presentation?

Answer 2

GN from damage to the basement membrane.

Hypertension, Haematuria + Proteinuria <3.5g/day.

Question 3

What is Nephrotic Syndrome + presentation?

Answer 3

GN caused by damage to glomerular capillaries.

Proteinuria >3.5g/day, Hypoalbuminemia (<25g/L serum albumin), oedema + hyperlipidemia.

Question 4

1ary Nephrotic Syndrome + Common Examples?

Answer 4

Direct damage to podocytes.

1) Minimal change disease
2) Membranous Nephropathy
3) Focal segmental glomerulosclerosis (FSGS)

Question 5

2ndary Nephrotic Syndrome + Common Examples?

Answer 5

Symptom of Systemic Disease

1) Diabetic Nephropathy
2) Systemic Amyloidosis

Question 6

Investigations for GN?

Answer 6

1) Bloods (FBC, U&Es, LFTs, Hepatitis serology, Complement, Auto-antibodies etc.) - determine cause
2) Urine dipstick + Microscopy: confirmed haematuria/proteinuria = send for culture
3) Renal ultrasound - screen for biopsy
4) Renal biopsy = gold standard diagnostic

Question 7

Management of GN?

Answer 7

1) Treat underlying disease
2) Salt restriction <2g/day, Fluid restriction 1-1.5L/day
3) Loop Diuretics - remove oedema (monitor by weight loss ~0.5-1kg/day)
4) ACE-i/ARBs - reduces proteinuria
5) Anti-coagulation - replaces antithrombin, protein C+S
(lost in proteinuria)

Question 8

Most common cause of GN?

Answer 8

IgA nephropathy (Nephritic)
Macroscopic Hematuria 1-2 days after Upper Respiratory Tract Infection 
Renal Biopsy (IgA deposits)

Question 9

Post Strep GN?

Answer 9

Nephritic: 1-2 weeks/3-6 weeks post-throat/skin infection. Antigen deposits on biopsy