Renal: Glomerulonephritis

Question 1

Outline some features of glomerulonephritis

Answer 1

Group of disorders resulting from glomerular damage

Can lead to proteinuria +/- haematuria

Can get AKI and/or end stage renal failure

Question 2

What are 3 presentations of glomerulonephritis?

Answer 2

Asymptomatic haematuria

Nephrotic syndrome

Nephritic syndrome

Question 3

What blood tests should be performed to investigate glomerulonephritis?

Answer 3

Basic: FBC, U+E, ESR

Complement: C3 and C4

Antibodies: ANA, dsDNA, ANCA, GBM

Serum protein electrophoresis and Ig

Infection: ASOT, HBC and HCV serology

Question 4

Which urine and imaging tests should be performed to investigate glomerulonephritis?

Answer 4

Urine

• Dipstick: look for proteinuria and haematuria
• MCA
• Bence-Jones protein

Imaging:

• CXR: look for infiltrates (Goodpasture’s and Wegener’s)
• Renal Us +/- biopsy

Question 5

Outline the management for glomerulonephritis

Answer 5

Refer to nephrologist

Manage HTN aggressively (=<130/80)

Include ACEi/ARB

Vol overload = Na/H20 restriction, diuretics

Hypoalbuminemia = LMWH (as at higher risk of VTE)

Immunosuppression

RRT

Question 6

Asymptomatic haematuria: name 3 causes

Answer 6

Type of Glomerulonephritis

Causes: IgA nephropathy, thin BM, Alport’s

Question 7

Asymptomatic haematuria: what are the features of IgA nephropathy?

Answer 7

Also called Berger’s disease (commonest GN in developed world) - accumulation over time of IgA in glomerulus, causing local inflammationa and destruction

Macroscopic haematuria occurring in young pts, a few days after URTI —> rapid rise in IgA can occasionally cause Nephritic syndrome

Question 8

Asymptomatic haematuria: what are the biopsy findings, management and prognosis of IgA nephropathy?

Answer 8

Biopsy: IgA deposition in mesangium

Management: steroids or cyclophosphamide if low renal function

Prognosis: 20% are in ESRF after 20 years

Question 9

Asymptomatic haematuria: what are the features of thin BM disease

Answer 9

Autosomal dominant - commonest cause of Asymptomatic haematuria (but small risk of ESRF) - only finding is thin BM in glomerulus

Features: Persistent, asymptomatic microscopic haematuria

Question 10

What is Alport syndrome and outline some features

Answer 10

Genetic disorder characterised by Glomerulonephritis, end stage kidney disease and deafness due to a defect in type IV collagen

Features

• haematuria and (as disease progresses), proteinuria
• sensorineural deafness
• Lens dislocation and cataracts
• retinal ‘flecks’

Question 11

How does nephrotic syndrome present?

Answer 11

Normal-mild BP increase

Proteinuria >3.5g/d

Normal-mild GFR decrease

Question 12

How does nephritic syndrome present?

Answer 12

Moderate-severe BP increase

Haematuria

Moderate-severe GFR decrease

Question 13

What are the causes of nephrotic syndrome?

Answer 13

Primary = membranous nephropathy, minimal change, FSGS

Secondary = DM, SLE, amyloid, hep B/C

Question 14

What are the causes of nephritic syndrome?

Answer 14

Primary = IgA nephropathy

Secondary = post strep, vasculitis, SLE