Nephrology: Glomerulonephritis

Question 1

Definition of Glomerulonephritis

Answer 1

Inflammation of the glomeruli and nephrons

Question 2

Classification of glomerulonephritis (types)

Answer 2

• IgA nephropathy (Berger’s Disease)
• Membranous Nephropathy
• Membranoproliferative glomerulonephritis
• Post – streptococcal glomerulonephritis.
• Rapidly progressive glomerulonephritis
• Anti-GBM disease (Goodpasture syndrome)

Systemic diseases that cause glomerulonephritis:
- Henoch- Schoenlein purpura
-Vasculitis
-Lupus nephritis
- Diabetes

Question 3

Brief overview of Berger’s disease:

Answer 3

IgA nephropathy (or Berger’s disease) is the most common cause of primary glomerulonephritis. The exact cause is unclear. The typical patient is in their 20s presenting with haematuria. Histology shows IgA deposits and mesangial proliferation. The mesangial cells are found in the centre of the glomerulus and help support the capillaries (as well as performing other functions).

Question 4

Brief overview of membranous nephropathy:

Answer 4

Membranous nephropathy involves deposits of immune complexes in the glomerular basement membrane, causing thickening and malfunctioning of the membrane and proteinuria. Histology shows IgG and complement deposits on the basement membrane. It is a key cause of nephrotic syndrome in adults. The majority (around 70%) are idiopathic. It can be secondary to malignancy, systemic lupus erythematosus or drugs (e.g. NSAIDs).

Question 5

Brief overview of membranoproliferative glomerulonephritis:

Answer 5

Membranoproliferative glomerulonephritis (or mesangio-capillary glomerulonephritis) typically affects patients under 30. It involves immune complex deposits and mesangial proliferation.

Question 6

Brief overview of post-streptococcal glomerulonephritis:

Answer 6

Post-streptococcal glomerulonephritis tends to affect patients under 30. It presents 1-3 weeks after a streptococcal infection (e.g., tonsillitis or impetigo). Patients usually make a full recovery.

Question 7

Brief overview of rapidly progressive glomerulonephritis:

Answer 7

Rapidly progressive glomerulonephritis (or crescentic glomerulonephritis) presents with an acute severe illness but tends to respond well to treatment. Histology shows glomerular crescents.

Question 8

Brief overview of Goodpasture syndrome:

Answer 8

Goodpasture syndrome is also known as anti-glomerular basement membrane (anti-GBM) disease. Anti-GBM (glomerular basement membrane) antibodies attack the glomerulus and pulmonary basement membranes. It causes glomerulonephritis and pulmonary haemorrhage. The typical presentation is a patient in their 20s or 60s with acute kidney failure and haemoptysis (coughing up blood).

Question 9

Pathogenesis of glomerulonephritis

Answer 9

Most GN are primary immune diseases which involve innate and acquired immune mechanisms.

injury to the glomeruli can be immune-complex deposition, auto-immune (ANCA vasculitis, anti GBM), T-cell mediated