Glomerulonephritis

Question 1

definition

Answer 1

Group of disorders where damage to the glomerulus causes a leak of protein (nephrotic) +/- blood (nephritic) into the urine

Question 2

Nephrotic syndrome

Answer 2

Inflammation damages glomerulus, 
proteins leak = proteinuria, 
low protein in the blood = hypoalbuminaemia, 
SEVERE oedema (reduced oncotic pressure and Na retention) 
Hyperlipidaemia (liver releases triglycerides to maintain osmotic pressure

Causes include: 
 Primary 
  - Minimal change disease
  - membraneous nephropathy 
  - focal segmental glomerulosclerosis
Secondary 
  - diabetes 
  - myeloma

Question 3

Nephritic syndrome

Answer 3

Inflammation damages glomerulus so much that blood freely enters and through this
= PROTEINURIA and HAEMATURIA
this causes decreased kidney perfusion and thus oliguria, and SUBSEQUENT HTN

causes: 
Primary 
  - IgA nephropathy 
  - rapidly progressive GN 
  - proliferative - post strepA, mesangial, crescentic
Secondary 
  - SLE 
  - Goodpasture's (autoimmune) 
  - myeloma

Question 4

Presentation of Nephrotic Syndrome

Answer 4

• Frothy urine (proteinuria)
• Oedema (hypoalbuminaemia)
• Severe hyperlipidaemia (TGs released by liver)

Question 5

Presentation of Nephritic syndrome

Answer 5

Haematuria 
Proteinuria 
Hypertension 
Oliguria 
Oedema (from HTN)

Question 6

Investigations

Answer 6

Urinanalysis (protein and RBC) 
ACR 
eGFR and Cr 
Bloods - FBC,UEC,LFT,ESR/CRP 
Autoantibodies (ANA,ANCA,anti-dsDNA,anti-GBM)
Renal USS +/- biopsy

Question 7

Management

Answer 7

refer to nephrologist

Nephrotic

• treat underlying cause
• diuretics for oedema
• ACEi to reduce proteinuria
• monitor BP

Nephritic

• treat underlying cause
• treat HTN
• ACEi/immunosuppression if AI