Nephrology - Nephritic syndrome Flashcards
Most common causes of haematuria
- Glomerulonephritis
- Post infectious glomerulonephritis
- IgA nephropathy
- Henoch-Schonlein purpura
- UTI
- Trauma
- Stones
Nephritic syndrome presentation
- Haematuria and proteinuria
- Reduced GFR
- Oliguria
- Fluid overload
- Raised JVP
- Oedema
- Hypertension
- Worsening renal failure = Rapidly Progressive Glomrular Nephritis
What type of AKI can nephritic syndrome cause?
Intrarenal AKI
Causes of glomerulonephritis
- Post Infectious glomerulonephritis
- IgA nephropathy
- Henoch Schonlein purpura (HSP)
- Membranoproliferative glomerulonephritis
- Lupus Nephritis
- ANCA positive vasculitis
Causes of acute post-infectious glomerulonphritis
- Usually Group A beta hemolytic streptococcus
- Site
- throat 7-10 days
- skin 2-4 weeks
Diagnosis of Acute Post-Infectious Glomerulonphritis
- Bacterial culture
- Positive ASOT
- Low C3 normalises
What is the prognosis of post-infectious glomerulonephritis
Good prognosis with no recurrence
How is Post-Infectious Glomerulonphritis treated?
- Antibiotic
- Support renal functions
- Overload / hypertension
- Diuretics
What is the most common glomerulonephritis?
IgA Nephropathy
Who does IgA nephropathy usually affect?
- Usually older children and adults
- 1-2 days after URTI
How does IgA Nephropathy present clinically?
- Recurrent macroscopic haematuria
- ± chronic microscopic haematuria
- Varying degree of proteinuria
Pathophysiology of IgA Nephropathy
- 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
Diagnosis of IgA nephropathy
- Clinical picture
- Negative autoimmune workup
- Normal compliment
- Confirmation Biopsy
How is IgA nephropathy treated?
- Mild disease
- proteinuria with ACEi
- Moderate to Severe disease
- immunosuppresion (KDIGO)
IgA nephropathy outcome
- variable
- 25% ESRF by 10 yrs post diagnosis
- Outcome better in children
Henoch Schonlein Purpura is also known as:
IgA related vasculitis
Henoch Schonlein Purpura age of onset
5-15 years old
How is a clinical diagnosis of Henoch Schonlein Purpura made?
- Palpable purpura
- AND one of:
- Abdominal pain
- Renal involvement
- Arthritis or arthralgia
- Biopsy
- IgA depostition
How is Henoch Schonlein Purpura triggered?
- 1-3 days post trigger
- Viral URTI in 70%
- Streptococcus, drugs
Henoch Schonlein Purpura duration of symptoms
- 4-6 weeks
- 1/3rd relapse
Mechanism of nephritis in Henoch Schonlein Purpura
Mesangial cell injury
Management of Henoch Schonlein Purpura
- 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
