Rapid glomerulonephritis

Question 1

Rapidly progressive glomerulonephritis: Cause

Answer 1

Primary type:
- idiopathic

Secondary:
- Type I: anti-GBM antibodies -> Goodpasture syndrome

• Type II: immune complexes -> Poststreptococcal glomerulonephritis, systemic lupus erythematosus, IgA nephropathy, Henoch-Schonlein purpura
• Type III: anti-neutrophilic cytoplasmic antibodies (ANCA)
  .Cytoplasmic ANCA (C-ANCA): Wegener’s granulomatosis
  .Perinuclear ANCA (P-ANCA): microscopic polyangiitis, Churg-Strauss syndrome

Question 2

Rapidly progressive glomerulonephritis: S, C

Answer 2

• hematuria

Complication: rapidly progresses to renal failure if untreated

Question 3

Rapidly progressive glomerulonephritis: D

Answer 3

• Light microscopy: crescent-shaped glomeruli
• Immunofluorescence
• Type I: linear, antibodies bind to collagen of glomerular basement membrane
• Type II: granular, immune complex deposition in subendothelium
• Type III: negative (pauci-immune), associated with ANCAs in blood

Question 4

Rapidly progressive glomerulonephritis: T

Answer 4

Pulse methylprednisolone, then:

• prednisone
• cyclophosphamide
• rituximab
• plasmapheresis

In case of renal failure -> dialysis + kidney transplant