Renal - Glomerulonephritis

Question 1

What is glomerulonephritis?

Answer 1

Inflammation of the glomeruli

Pathology that occurs in various diseases, is not a disease in itself therefore treat underlying causes

Question 2

What is nephritic syndrome?

Answer 2

Group of features that occur with nephritis

Haematuria (macroscopic or microscopic)
Oliguria
Proteinuria
Fluid retention

N
E
Proteinuria
Haematuria
Retention of fluid
olIguria
T
I
C

Question 3

What is nephrotic syndrome?

Answer 3

Basement membrane in the glomerulus becomes highly permeable causing significant proteinuria

Proteinuria
Low serum albumin
Peripheral oedema
Hypercholesterolaemia

Question 4

How does nephrotic syndrome present?

Answer 4

With oedema

Frothy urine due to high protein

Question 5

What does nephrotic syndrome predispose a patient to?

Answer 5

Thrombosis
Hypertension
High cholesterol

Question 6

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

Answer 6

Minimal change disease

• Idiopathic
• Treated successfully with steroids

Question 7

What are the most common causes of nephrotic syndrome in adults?

Answer 7

Membranous nephropathy
Focal segmental glomerulosclerosis

Question 8

What are some potential causes of nephrotic syndrome?

Answer 8

Membranoproliferative glomerulonephritis
Henoch-Schonlein purpura
Diabetes
Infection (HIV)

Question 9

What is IgA nephropathy?

Answer 9

Type of glomerulonephritis

Typical patient
Patient in 20s with haematuria

Histology
IgA deposits
Mesangial proliferation

Question 10

What is membranous nephropathy?

Answer 10

Type of glomerulonephritis

Deposits of immune complexes in the glomerular basement membrane
- Causes thickening and malfunctioning of the membrane and proteinuria

Histology
IgG and complement deposits on the basement membrane

Key cause of nephrotic syndrome in adults

Question 11

What causes membranous nephropathy?

Answer 11

Mainly idiopathic

Can be secondary to malignancy, SLE or NSAIDs

Question 12

What is membranoproliferative glomerulonephritis?

Answer 12

AKA Mesangiocapillary glomerulonephritis

Typically affects patients under 30

Histology
Immune complex deposits
Mesangial proliferation

Question 13

What is post-streptococcal glomerulonephritis?

Answer 13

Affects patients under 30

1-3 weeks post streptococcal infection (tonsillitis or impetigo)

Patients make full recovery

Question 14

What is rapidly progressive glomerulonephritis?

Answer 14

AKA Crescentic glomerulonephritis

Acute severe illness but responds well to treatment

Histology
Glomerular crescents

Question 15

What is Goodpasture syndrome?

Answer 15

AKA anti-glomerular basement membrane disease (anti-GBM)

Anti-GBM antibodies attack the glomerulus and pulmonary basement membranes

Causes glomerulonephritis and pulmonary haemorrhage

Typical patient is in their 20s or 60s with AKI and haemoptysis

Question 16

What systemic diseases cause glomerulonephritis?

Answer 16

Henoch-Schonlein purpura
Vasculitis (microscopic polyangiitis or granulomatosis with polyangiitis)
Lupus nephritis (associated with SLE)

Question 17

If a patient presents with significant AKI and haemoptysis how can you differentiate based on antibodies?

Answer 17

Anti-GBM- Goodpasture syndrome

p-ANCA or MPO antibodies- microscopic polyangitis

c-ANCA or PR3 antibodies- granulomatosis with polyangiitis

Question 18

How are patients with glomerulonephritis managed?

Answer 18

Diagnosis may require renal biopsy for histology

Supportive care
Immunosuppression