Nephrology - Nephritic syndrome

Question 1

Most common causes of haematuria

Answer 1

• Glomerulonephritis
• Post infectious glomerulonephritis
• IgA nephropathy
• Henoch-Schonlein purpura
• UTI
• Trauma
• Stones

Question 2

Nephritic syndrome presentation

Answer 2

• Haematuria and proteinuria
• Reduced GFR
  
  • Oliguria
  • Fluid overload
    
    • Raised JVP
    • Oedema
  • Hypertension
  • Worsening renal failure = Rapidly Progressive Glomrular Nephritis

Question 3

What type of AKI can nephritic syndrome cause?

Answer 3

Intrarenal AKI

Question 4

Causes of glomerulonephritis

Answer 4

• Post Infectious glomerulonephritis
• IgA nephropathy
• Henoch Schonlein purpura (HSP)
• Membranoproliferative glomerulonephritis
• Lupus Nephritis
• ANCA positive vasculitis

Question 5

Causes of acute post-infectious glomerulonphritis

Answer 5

• Usually Group A beta hemolytic streptococcus
• Site
  
  • throat 7-10 days
  • skin 2-4 weeks

Question 6

Diagnosis of Acute Post-Infectious Glomerulonphritis

Answer 6

• Bacterial culture
• Positive ASOT
• Low C3 normalises

Question 7

What is the prognosis of post-infectious glomerulonephritis

Answer 7

Good prognosis with no recurrence

Question 8

How is Post-Infectious Glomerulonphritis treated?

Answer 8

• Antibiotic
• Support renal functions
• Overload / hypertension
  
  • Diuretics

Question 9

What is the most common glomerulonephritis?

Answer 9

IgA Nephropathy

Question 10

Who does IgA nephropathy usually affect?

Answer 10

• Usually older children and adults
• 1-2 days after URTI

Question 11

How does IgA Nephropathy present clinically?

Answer 11

• Recurrent macroscopic haematuria
• ± chronic microscopic haematuria
• Varying degree of proteinuria

Question 12

Pathophysiology of IgA Nephropathy

Answer 12

• Increased circulating levels of Gd-IgA
• Production of IgA1 antibodies (IgA or IgG)
• Immune complexes form in the circulation in situ
• Immune complexes in the mesangium cause local immune activation and injury

Question 13

Diagnosis of IgA nephropathy

Answer 13

• Clinical picture
  
  • Negative autoimmune workup
  • Normal compliment
• Confirmation Biopsy

Question 14

How is IgA nephropathy treated?

Answer 14

• Mild disease
  
  • proteinuria with ACEi
• Moderate to Severe disease
  
  • immunosuppresion (KDIGO)

Question 15

IgA nephropathy outcome

Answer 15

• variable
• 25% ESRF by 10 yrs post diagnosis
• Outcome better in children

Question 16

Henoch Schonlein Purpura is also known as:

Answer 16

IgA related vasculitis

Question 17

Henoch Schonlein Purpura age of onset

Answer 17

5-15 years old

Question 18

How is a clinical diagnosis of Henoch Schonlein Purpura made?

Answer 18

• Palpable purpura
• AND one of:
  • Abdominal pain
  • Renal involvement
  • Arthritis or arthralgia
  • Biopsy
    
    • IgA depostition

Question 19

How is Henoch Schonlein Purpura triggered?

Answer 19

• 1-3 days post trigger
• Viral URTI in 70%
• Streptococcus, drugs

Question 20

Henoch Schonlein Purpura duration of symptoms

Answer 20

• 4-6 weeks
• 1/3rd relapse

Question 21

Mechanism of nephritis in Henoch Schonlein Purpura

Answer 21

Mesangial cell injury

Question 22

Management of Henoch Schonlein Purpura

Answer 22

• Symptomatic
  
  • Joints, gut
• Glucocorticoid therapy
  
  • Not helpful in renal disease
  • May help with gastrointestinal involvement
• Immmunosuppresion
  
  • Trial in moderate to severe renal disease
• Long term
  
  • Hypertension and proteinuria screening