NEPHRITIC SYNDROME

Question 1

What is nephritic syndrome

Question 2

Pathophysiolgy of nephritic syndrome

Answer 2

GBM damage - WBC, protein & cytokines in bowman’s space - Fibrosis, sclerosis & epithelial cells proliferation - parietal layer of bowmans capsule proliferation - Glomerular crescents - low GFR - rapidly progressive glomerulonephritis - leads to renal failure

Question 3

Components of glomerular filtration barrier

Answer 3

Fenestrated capillary
Glomerular basement membrane (-vely charged)
Podocytes (have filtration slots)

Question 4

Causes of nephritic syndrome

Answer 4

1) ANTI-GBM DISEASE/ GOOD PASTURE SYNDROME

2) ANCA VASCULITIS
a) WEGNER’S GRANULOMATOSIS (GPA)
b) EOSINOPHILIC POLYANGITIS (EPA)/CHURG-STRAUSS SYNDROME
c) MICROSCOPIC POLYANGITIS (MPA)

3) HEREDITARY NEPHRITIS/ ALPORT SYNDROME

4) IMMUNE COMPLEX DEPOSITION DISEASES
a) Post-streptococcal glomerulonephritis (PSGN)
b) IgA nephropathy
c) Lupus Nephritis
d) Membranoproliferative glomerulonephritis

Question 5

Which causes of nephritic syndrome have NEPHROTIC range proteinuria

Answer 5

Lupus nephritis
Membranoproliferative glomerulonephritis

Question 6

Which causes of nephritic syndrome lead to rapidly progressive glomerulonephritis (RPGN)

Answer 6

ANTI-GBM disease/ Good pasture syndrome
ANCA vasculitis
Post-streptococcal glomerulonephritis (PSGN)
IgA nephropathy
Lupus nephritis

Question 7

Which causes of nephritic syndrome cause C3 consumption

Answer 7

• Post-streptococcal glomerulonephritis (PSGN)
• Lupus Nephritis
• Type 2 membranoproliferative glomerulonephritis

Question 8

Which causes of nephritic syndrome cause formation of glomerular crescents

Answer 8

ANTI-GBM
ANCA VASCULITIS
PSGN
IgA NEPHROPATHY
LUPUS NEPHRITIS

Question 9

Diagnosis of nephritic syndrome

Answer 9

1) URINALYSIS WITH MICROSCOPY
2) 24hr PROTEIN/ UACR
3) RENAL FUNCTION TEST
4) SEROLOGY
5) RENAL BIOPSY

Question 10

Treatment of nephritic Syndrome

Answer 10

1) PROTEINURIA
Low protein diet
ACE inhibitors
ARBs
2) EDEMA
Diuretics
Fluid & Na restrictions
3) HYPERTENSION
- restrict RAAS
ACE inhibitors
ARBs
4) UNDERLYING CAUSE
Acute Steroids (RPGN, MPGN)
Plasmapheresis (Anti-GBM, ANCA)
Long-term immunosuppressants

Question 11

Which cause of nephritic syndrome cause subendothelial and subepithelial deposition of immune complex

Answer 11

Lupus nephritis

Question 12

Which cause of nephritic syndrome does not cause antibody/ immune complex deposition

Answer 12

ANCA vasculitis

Question 13

Which cause of nephritic syndrome cause mesangial deposition of immune complex

Answer 13

IgA nephropathy

Question 14

Which cause of nephritic syndrome causes C3 dense deposits

Answer 14

MPGN type II