Nephritis syndrome

Question 1

Signs and symptoms

Answer 1

Painless macroscopic hematuria, with
dysmorphic RBCs aka acanthocytes
RBC casts in urine

Mild hypertension - from decreased GFR and RAAS activation.

Periorbital edema

Oliguria

Decreased GFR and Azotemia,

Mild proteinuria, <3.5 g/day

Question 2

Causes of Nephritic syndrome

Answer 2

1. IgA nephropathy, aka Berger disease
2. Henoch-schonlein purpura, systemic IgA nephropathy and small vessel vasculitis.
3. RPGN
4. Acute postinfectious GN
5. Goodpasture syndrome
6. SLE - immune complex mediated, types 2-4 of SLE nephropathy (type 5 is membranous GN and is nephrotic)
7. Wegener’s granulomatosis
8. Hemolytic uremic syndrome
9. Infective endocarditis
10. Alport syndrome - Mutation of Type 4 collagen, main component of GBM, nephrosis leading to ESRD

Question 3

What do the glomeruli look like on biopsy in nephritis syn.

Answer 3

Hypercellular and inflammed.

Bilateral involvment (ie not unilateral pyelonephritis)

Question 4

IgA nephropathy treatment

Answer 4

<1g/day proteinuria, just BP control, ACEIs and ARBs
above 1g/day proteinuria, Steroids or cyclophosphamide addition

Increased creatinine = prednisolone

Crescents = Methylprednisolone IV and cyclophosphamide.

Question 5

Diabetic nephropathy treatment

Answer 5

ACEi’s slows nephropathy,

all of the other diabetic treatments as well.