NEPHRITIC SYNDROME

Question 1

What is the major determinant of whether disease process leads to nephritic or nephrotic syndrome?

Answer 1

Site of glomerular injury

• Limited to podocytes: protein loss only → nephrotic
• Includes endothelial and mesangial cells: exposed to inflammatory blood elements → nephritis → loss of red blood cells and protein → nephritic

Question 2

A child who has had strep throat infection 2 to 3 weeks ago and has developed symptoms of leg swelling and this urine is likely to have which condition?

What is the pathophysiology?

Answer 2

Post streptococcal GN: Nephritic syndrome

Sequela of pharyngitis or skin infections caused by nephritogenic strains of S. pyogenes (group A strep)

Question 3

What is seen in the image? What is this virtually diagnostic of?

Answer 3

Subepithelial humps seen under electron microscopy: post streptococcal GN

→ classic diagnostic finding is glomerular subepithelial electron-dense immune-type deposits, ‘humps’. Commonly found on part of glomerular basement membrane overlying mesangium

Question 4

what is the management for post streptococcal GN?
What is the prognosis for post streptococcal GN in children and adults?

Answer 4

no specific management: supportive therapy

• ​Children: good prognosis, 95% recover
• Adults: 60% recover, many develop renal insufficiency and can go on to develop rapidly progressive GN. Can occur 10 to 40 years after initial illness

Question 5

What is the most common form of GN worldwide? What does this leads to in around 50% of patients? What is the pathophysiology?

Answer 5

IgA nephropathy (Burger’s disease)

• overactive immune system, increased IgA synthesis in response to triggers such as respiratory and GI infection. IgA complexes deposit in mesangium
• about half of patients eventually develop end stage renal disease

Question 6

A patient with episodes of haematuria days after URTI or diarrhoeal disease should be considered for which condition?

which 2 renal conditions that can follow an upper respiratory tract infection should this condition not be confused with?

Answer 6

IgA nephropathy (Berger’s disease)

• Post streptococcal GN: weeks after infection
• Minimal change disease: nephrotic syndrome after URTI

Question 7

What is the most common subtype of lupus renal disease?

Answer 7

Diffuse proliferative glomerulonephritis

Question 8

Crescents under light microscopy indicate which type of renal condition?

Answer 8

Rapidly progressive glomerulonephritis

Question 9

The classic triad of symptoms: heamaturia, hearing loss, ocular disturbance in a boy is likely which condition? Explain the pathophysiology

Answer 9

Alport syndrome

Genetic type IV collagen defect. X linked dominant: family history important

Question 10

Which condition causes bleeding from the lungs and kidney failure?

Answer 10

Goodpasture syndrome (GPS), AKA anti-glomerular basement membrane disease

• rare autoimmune disease
• antibodies attack basement membrane in lungs and kidneys