Nephritic syndrome

Question 1

What are the main abnormalities seen in nephritic syndrome?

Answer 1

1. Haematuria - micro or macro
2. Proteinuria - small amount
3. HTN - usually mild
4. Low urine volume - <300ml/day due to reduced renal function

Question 2

What is a distinguishing feature of nephritic syndrome that indicates glomerular damage?

Answer 2

red cell casts
(a urinary cast composed of a matrix containing red blood cells in various stages of degeneration and visibility, characteristic of glomerular disease or renal parenchymal bleeding)

Question 3

What are the causes of nephritic syndrome?

Answer 3

• post strep GN
• IgA nephropathy
• Rapidly progressive GN:
  Goodpastures or vasculitic (Wegeners, microscopic polyangiitis, Churg-strauss)
• Membranoproliferative GN
• Henoch Schonlein purpura

Question 4

What are the symptoms in IgA nephropathy

Answer 4

Asymptomatic non-visible haematuria
or 
episodic visible haematuria 
WITHIN 72hrs of infection 
Raised BP 
Proteinuria <1g

Question 5

How is a diagnosis of IgA nephropathy

Answer 5

renal biopsy where there is IgA deposition in mesangium

Question 6

What is the treatment of IgA nephropathy

Answer 6

ACEi, ARB reduced proteinuria + protect renal function

CS + fish oil if persistent proteinuria >1g despite 3-6m of ACEi/ARB +GFR > 50

Question 7

What is Henoch Schonlein Purpura

Answer 7

Small vessel vasculitis + systemic variant of IgA nephropathy w IgA deposits in skin/joints/guts/ kidney

Question 8

What is the presentation of HSP

Answer 8

• purpuric rashon extensor surfaces
• flitting polyarthritis
• abdo pain (GI bleeding)
• nephritis

Question 9

How is a diagnosis of HSP made

Answer 9

Usually clinical
+ve IF for IgA + C3 in skin
Renal biopsy is same as IgA N

Question 10

What is the treatment for HSP

Answer 10

Same as IgAN

steroids for gut

Question 11

What is post strep GN?

Answer 11

Strep antigens deposited in glomerulus leading to immune complex formation and inflammation

Question 12

What strep infections lead to post strep GN and how long after?

Answer 12

throat - 2 weeks

skin - 3-6 weeks

Question 13

How is a diagnosis of post strep GN made?

Answer 13

evidence of strep infection:

raised ASOT, anti-DNAse B, reduced C3

Question 14

What is the treatment of post strep GN?

Answer 14

supportive + abx

Question 15

What is anti-GBM disease? what is it also known as?

Answer 15

Goodpasture’s disease

auto-abs to type IV collagen in glomerular and alveolar BM

Question 16

What is the presentation of anti-GBM disease?

Answer 16

1. Renal disease - haematuria, AKI, oliguria/anuria, RF

2. Lung disease - palm haemorrhage -> SOB + haemoptysis

Question 17

What indicates a poor prognosis of anti-GBM disease?

Answer 17

Dialysis dependence at presentation

Increased no of crescents on biopsy

Question 18

How is anti-GBM disease diagnosed?

Answer 18

anti-GBM in circulation/kidney

Question 19

What is the treatment of anti-GBM disease

Answer 19

plasma exchange
CS
Cyclophosphamide

Question 20

Why is rapidly progressive GN significant/

Answer 20

aggressive, quickly leads to renal failure in days or weeks

Question 21

What are the causes of rapidly progressive GN

Answer 21

small vessel/ANCA vasculitis (lupus, nephritis)
anti-GBM disease
Other GNs may transform to become rapidly progressive including IgA nephropathy, membranous etc

Question 22

How is a diagnosis of rapidly progressive GN made

Answer 22

Renal biopsy - breaks in GBM allow an influx of inflammatory cells so crescents are seen (crescentic GN)

Question 23

What is the treatment of rapidly progressive GN?

Answer 23

CS + cyclophosphamide
Other Rx depends on aetiology e.g. plasma exchange for anti-GBM/ANCA vasculitis
Poss role for monoclonal abs in lupus nephritis