Glomerulonephritis And Nephrotic Syndromes

Question 1

What is glomerulonephritis?

Answer 1

Inflammation of the glomeruli in the kidneys

Question 2

What is the overall general treatment principles for glomerulonephritis?

Answer 2

Treat targeted at underlying cause
Supportive care and immunosuppression like corticosteroids

Question 3

What is nephritic syndrome?

Answer 3

A group of features that occurs with nephritis (inflammation of the kidney)

Question 4

What are the features of nephritic syndrome?

Answer 4

Haematuria
Oliguria (significantly reduced urine. Output)
Proteinuria
Fluid retention

Question 5

What is nephrotic syndrome?

Answer 5

When the basement membrane of the glomerulus becomes highly permeable causing significant proteinuria

Question 6

What are the features of nephrotic syndromes?

Answer 6

Significant proteinuria
Low serum albumin (lost in urine)
Peripheral odema (loss of oncotic pressure due to hypoalbuminaemia)
Hypercholesterolaemia (due to inc albumin production)

Question 7

What effect does significant protienuria in nephrotic syndrome have on the urine?

Answer 7

Makes it frothy

Question 8

What are some complications of nephrotic syndrome?

Answer 8

Thrombosis
HTN
High cholesterol

Question 9

What is the most common nephrotic syndrome in kids (2-5)?

How would it present?

Answer 9

Minimal change disease

Odema
Proteinuria
Low albumin

Question 10

How would you treat minimal change disease?

Answer 10

Corticosteroids

Question 11

What are some nephrotic syndromes for adults?

Answer 11

Diabetic nephropathy
Focal Segmental Glomerulosclerosis
Membranous glomerulonephritis
Infection

Question 12

What is the pathophysiology of minimal change disease?

Answer 12

Foot processes damaged
So gaps in basement membrane large allowing protien leakage

Question 13

How to remember main difference in presentation for Nephritic and Nephrotic syndromes?

Answer 13

NephItic = Inflammation of glomerular basement membrane causing Haematuria

NephrOtic = POdOcyte damage of basement membrane. Causing Odema (charge of podocytes not repelling albumin)

Question 14

What are some types of glomerulonephritis?

Answer 14

IgA nephropathy (bergers disease)
Goodpastures syndrome (anti-GBM glomerular basement membrane)
Rapidly progressing glomerulonephritis
Post streptococcal glomerulonephritis

Question 15

What is IgA nephropathy?

How does it typically present?

Answer 15

IgA deposits and mesangial proliferation

20yr old
Haematuria
Most common cause of primary glomerulonephritis

Question 16

What is Goodpasture syndrome?

Answer 16

Anti-GBM antibodies attack glomerulus (Type IV collagen in basement membrane) and pulmonary basement membrane leading to glomerulonephritis. And pulmonary haemorrhage

Question 17

What is a typical presentation of Goodpasture syndrome?

Answer 17

20-60y/o patient
Acute Kidney Failure and Haemoptysis

Question 18

What is rapidly progressive glomuerlonephritis?
How does it look on histology?

Answer 18

Severe glomerular injury

Crescent shaped masses on histology

Question 19

What is post streptococcal glomerulonephritis?
What is recovery like?

Answer 19

1-3 weeks after infection by group A Beta haemolytic streptococcal infection of pharynx,tonsils or skin

Kidneys normally fully recover after Abx given to treat remaining infection

Question 20

What are some systemic disease that can cause glomerulonephritis?

Answer 20

HSP (Henoch-Schonlein purpura)
Vasculitis
Lupus nephritis

Question 21

What antibodies can you test for to determine cause of kidney injury?

Answer 21

Anti-GBM. Antibodies = Goodpasture syndrome
P-ANCA = microscopic polyangiitis (Vasculitis)
C-ANCA = granulomatosis with polyangiits (vasculitis)

Question 22

How do you diagnose the cause of a nephrotic or nephritic syndrome?

Answer 22

Renal biopsy for Histology

Question 23

How do you manage nephrotic or nephritic syndromes?

Answer 23

Supportive care:
-HTN management (ACEi)
-Diuretics if oedematous
-DIALYSIS in severe cases

Immunosupression:
-corticosteroids

Question 24

What kidney disease is linked to IBD?

Answer 24

IgA nephropathy (glomerulonephritis)