Glomerulonephritis

Question 1

What is nephritis?

Answer 1

• Generic term for kidney inflammation

- Non-specific term which is not a diagnosis

Question 2

What is nephritic syndrome?

Answer 2

• A group of symptoms, not a diagnosis
• Clinical picture of having inflammation of the kidney (not a specific diagnosis or underlying cause)
• No set criteria but does have certain features

Question 3

What are the features of nephritic syndrome?

Answer 3

• Haematuria either visible or not (macro/micro)
• Oliguria (reduced urine)
• Proteinuria is less than 3g / 24 hours
• Fluid retention

Question 4

What is nephrotic syndrome?

Answer 4

• A group of symptoms without a stated cause

- Has set criteria

Question 5

What are the criteria for nephrotic syndrome?

Answer 5

• Peripheral oedema
• Proteinuria more than 3g / 24 hours
• Serum albumin less than 25g / L
• Hypercholesterolaemia

Question 6

What is glomerulonephritis?

Answer 6

An umbrella term for conditions that cause inflammation of, or around, the glomerulus. Many conditions are a glomerulonephritis, and each diagnosis has its own pathophysiology.

Question 7

What are the types of glomerulonephritis?

Answer 7

• Minimal change disease
• Focal segmental glomerulosclerosis
• Membranous glomerulonephritis
• Berger’s disease
• Post streptococcal glomerulonephritis
• Mesangiocapillary glomerulonephritis
• Rapidly progressive glomerulonephritis
• Goodpasture Syndrome

Question 8

What is interstitial nephritis?

Answer 8

• Inflammation of the space between cells and tubules (the interstitium) within the kidney- IT IS NOT GLOMERULONEPHRITIS
• Split into acute interstitial nephritis and chronic tubulointerstitial nephritis

Question 9

What is glomerulosclerosis?

Answer 9

• The pathological process of scarring of the tissue in the glomerulus
• Caused by glomerulonephritis, obstructive uropathy or focal segmental glomerulosclerosis

Question 10

What is Goodpasture Syndrome?

Answer 10

• Antibodies against the glomerular and pulmonary basement membranes
• Causes AKI and haemoptysis

Question 11

How are most types of Glomerulonephritis treated?

Answer 11

• Immunosuppression

- Blood pressure control (RAAS interference)

Question 12

How does nephrotic syndrome typically present?

Answer 12

• Oedema
• Frothy urine (proteinuria)
• Thrombosis, HTN, hypercholesterolaemia

Question 13

What is the most common cause of nephrotic syndrome in children and how is it treated?

Answer 13

Minimal change disease

Question 14

What is the most common cause of nephrotic syndrome in adults?

Answer 14

Focal segmental glomerulosclerosis

Question 15

Summarise Berger’s Disease.

Answer 15

• Most common PRIMARY glomerulonephritis
• IgA nephropathy
• Peak presentation in 20s
• Histology shows “IgA deposits and glomerular mesangial proliferation”

Question 16

Summarise membranous glomerulonephritis.

Answer 16

• Most common type of glomerulonephritis overall
• There is a bimodal peak in age in the 20s and 60s
• Histology shows “IgG and complement deposits on the basement membrane”
• Majority (~70%) are idiopathic
• 2° to malignancy, rheumatoid disorders and drugs (e.g. NSAIDS)

Question 17

Summarise post-strep glomerulonephritis.

Answer 17

• Patient typically under 30
• 1-3 weeks post-strep infection (e.g. tonsillitis or impetigo)
• They develop a nephritic syndrome
• Usually a full recovery

Question 18

Summarise rapidly progressive glomerulonephritis.

Answer 18

• Histology shows “crescentic glomerulonephritis”
• It presents with a very acute illness with sick patients but responds well to treatment
• Often secondary to Goodpasture syndrome