Nephritic syndrome / glomerulonephritis

Question 1

Nephritic syndrome characteristics

Answer 1

Haematuria with red-cell casts
Proteinuria
Hypertension
Oedema --> periorbital, leg, sacral
Temporary oliguria and uraemia

Question 2

Rapidly progressive glomerulonephritis (RPGN) (crescentic) the 3 groups ?

Answer 2

Anti-GBM
Immune complex deposition complication –> e.g. IgA nephropathy, lupus nephritis etc.
Pauci-immune RPGN –> often ANCA

Question 3

Post-streptococcal glomerulonephritis

Answer 3

Childhood, after infection (throat, otitis media, skin)
Proliferation glomerular cells,
immune complexes, granular deposits,
hypercellular glomeruli obliterate capillary lumens

Question 4

IgA nephropathy

Answer 4

Children and young males
haematuria following uppery respiratory or GI viral infection
focal & segmental glomerulonephritis with mesangial deposits IgA –> activate mesangial cells to produce more matrix
Treat: ACE-i or AngII-receptor antagonist

Question 5

Alport syndrome

Answer 5

haematuria, proteinuria, high-frequency nerve deafness
GBM abnormal, podocytes & slit diaphragm normal
Treat: ACE-i

Question 6

Anti-GBM glomerulonephritis

Answer 6

linear deposits, disruption filtration barrier
Goodpasture syndrome (lung haemorrhage)
Never in patients with alport syndrome
Treat: plasma exchange + steroids

Question 7

ANCA-positive small vessel vasculitis

Answer 7

GPA, MPA, renal-limited vasculitis (no systemic features)
cANCA (PR3-ANCA)= GPA, bit MPA
pANCA (MPO-ANCA) = renal-limited vasculitis, bit MPA
Treat: high-dose corticosteroids