Glomerulonephritis

Question 1

Define Glomerulonephritis

Answer 1

Glomerulonephritis is a glomular disease that are generally characterised by inflammatory changes in glomerular capillaries and glomerular basement membranes
Inflammation are usually immune mediated
IgA-idiopathic-IgA deposits in kidneys-immune related more than kidney related

can be caused by so many diseases
Membranous GN, minimal change disease, focal, segmental GN, IgA GN, anti GBM and lupus nephritis

Question 2

Aetiology and risk factors of Glomerulonephritis

Answer 2

can result from renal-limiting disease or systemic disease (SLE)
damage caused is usually due to leukocytes, Antibodies and complement activation
Cellular deposition and complement activation both causes vicious cycle-
consequence of many disease-but commonly idiopathic

conditions include:
Infections, Systemic diseases (SLE/vasculitis), Drugs (NSAID, cocaine), Metabolic (DM, HTN, thyroiditis), malignancy (Lung, colorectal, etc), deposition (amyloidosis)

Minimal change GN-nephrotic, but no change in kidney visible except with immunostaining
Focal segmental GN (idiopathic/after Drugs/infection)-scarring/sclerosis of GN
Membranous-most often idiopathic-AID-complement complexes deposit within the basement layer of GN-destroy cell and architecture
Anti-GBM disease-AID damaging lung and kidney-targeting GBM AB

classified according to Sx
Nephrotic (proteinuria, Hypoalbimunia, hyperlipidiema and oedema)--
Deposition disease (amyloidosis), Minimal change disease (idiopathic), focal and segmental GN (idiopathic), Membranous (idiopathic) and membroproliferative GN

Nephritic- (heamaturia, sub-nephrotic range proteinuria, HTN)
IgA GN, post infection GN, rapidly progressing GN (vasculitis or anti GBM disease),

focal segmental GN seems to be highest cause amongst black
idiopathic membranous GN is most common over 40

Question 3

Epidiemology of Glomerulonephritis

Answer 3

Diagnosis is often missed, especially because many have subclinical GN

focal segmental GN seems to be highest cause amongst black
idiopathic membranous GN is most common over 40

IgA common in France, Australia

GN is most common cause of end stage kidney disease

Question 4

Signs and Sx of Glomerulonephritis

Answer 4

Milder forms are totally asymtomatic
and need specialist-you just need to recognise general

always has at least microscopic heamturia and proteinuria–
PC-pain in flanks, HTN, oedema, hematuria-but often incidental finding on dipstick, foamy urine

frank blood in urine is nephritic syndrome-much rarer-severe HTN

from there, measure GFR, proteinuria, BP and renal stones

if nothing suspicious and just microscopic heamatoruia-wait and see

If patient has nothing but risk factors for cancer-bladder cancer

Most common in GN–> see/measure proteinuria/changes in GFR -> suspect GN
measuring Albumin, glucose, complement and tons of autoimmune AB can help finish suspicions

Most common cause in children-minimal change
Young adults-focal segmental and minimal change
Membranous more common in older

Focal segmental-commonly only heavy proteinuria (not rest of nephrotic syndrome)
IgA, membranoproliferazive and post infection-usually nephritic picture with more frank blood

Question 5

Investigations of Glomerulonephritis

Answer 5

Its nearly all Ix based-
initial PC-heamturia, foamy urine, HTN, oedema, pain in flank
microcytic

heamatouria is nearly always there

Key Is from there-
repeat dipstick to confirm

Then measure BP, GFR, Proteinuria,, cancer risk factors

If see repeat heamatouria and a drop in GFR/proteinuria/increase in BP—> suspect GN and refer

Ultrasound is important to rule out kidney stones as cause
and cytoscopy if pt has cancer risk factors-bladder cancer