Glomerulonephritides

Question 1

Typically presents with nephritic syndrome (haematuria, hypertension) ?

Answer 1

1) Rapidly progressive glomerulonephritis - aka crescentic glomerulonephritis
= good pasture’s
=ANCA positive vasculitis
(for both plasma exchange)

2) IgA nephropathy - aka Berger’s disease, mesangioproliferative GN
=haematuria following an URTI
NO HYPERTENSION

2) Associated conditions
alcoholic cirrhosis
coeliac disease/dermatitis herpetiformis
Henoch-Schonlein purpura

Question 2

Mixed nephritic/nephrotic presentation

Answer 2

Diffuse proliferative glomerulonephritis
=post-streptococcal glomerulonephritis in child
=presents as nephritic syndrome acute kidney injury
common form of renal disease in SLE

Membranoproliferative / mesangiocapillary glomerulonephritis (mesangiocapillary)
type 1: cryoglobulinaemia, hepatitis C
type 2: partial lipodystrophy

Question 3

Typically presents with nephrotic syndrome (proteinuria, oedema)

Answer 3

Minimal change disease
= causes: Hodgkin’s, NSAIDs
good response to steroids

Membranous glomerulonephritis
cause: infections,
rheumatoid drugs,
malignancy,
idopathic
1/3 resolve, 1/3 respond to cytotoxics, 1/3 develop chronic kidney disease
=proteinuria / nephrotic syndrome / chronic kidney

Focal segmental glomerulosclerosis
idiopathic or secondary to HIV, heroin
=

Question 4

Henoch scholen purpura also known as BERGER DISEASE if A nephropathy features

Answer 4

No hypertension

palpable purpuric rash (with localized oedema) over buttocks and extensor surfaces of arms and legs
abdominal pain
polyarthritis
features of IgA nephropathy may occur e.g. haematuria, renal failure

Question 5

Treatment of henoch scholen purpura ?

Answer 5

treatment of nephropathy is generally supportive.

inconsistent evidence for the use of steroids and immunosuppressants

Prognosis
usually excellent, HSP is a self-limiting condition, especially in children without renal involvement

around 1/3rd of patients have a relapse

Question 6

complications of nephritic syndrome ?

Answer 6

Complications
increased risk of thromboembolism related to loss of antithrombin III and plasminogen in the urine
deep vein thrombosis, pulmonary embolism
renal vein thrombosis, resulting in a sudden deterioration in renal function
hyperlipidaemia
increasing risk of acute coronary syndrome, stroke etc
chronic kidney disease
increased risk of infection due to urinary immunoglobulin loss
hypocalcaemia (vitamin D and binding protein lost in urine)