Glomerulonephritis

Question 1

What is glomerulonephritis?

Answer 1

Inflammation of the glomeruli

Question 2

What are the 2 types of syndromes which occur with the kidneys?

Answer 2

• Nephritic
• Nephrotic

Question 3

What is nephritic syndrome?

Answer 3

• Haematuria
• Reduced urine output
• Proteinuria but minimal
• Fluid retention

Question 4

What is the most common cause of primary glomerulonephritis?

Answer 4

IgA nephropathy - occurs in younger patients following an URTI with histology showing IgA deposits and mesangial proliferation

Question 5

What are other causes of nephritic syndrome?

Answer 5

• Membranoproliferative glomerulonephritis - immune complex deposits and mesangial proliferation
• Post-strep glomerulonephritis which presents 1-3 weeks after a strep infection
• Systemic diseases e.g. HSP, SLE and microscopic polyangiitis or granulomatosis with polyangiitis

Question 6

What are the renal biopsy features of post-strep glomerulonephritis?

Answer 6

• Endothelial proliferation with neutrophils
• Sub epithelial humps due to lumpy immune complex deposits
• Immunofluorescence shows ‘starry sky’ appearance

Question 7

What is nephrotic syndrome?

Answer 7

Where the basement membrane in the glomerulus becomes highly permeable resulting in proteinuria

Question 8

What are the features of nephrotic syndrome?

Answer 8

• Proteinuria
• Low serum albumin
• Peripheral oedema
• Hypercholesterolemia

Question 9

What does nephrotic syndrome predispose to?

Answer 9

• Thrombosis
• HTN
• High cholesterol

Question 10

What is the main cause of nephrotic syndrome in children?

Answer 10

Minimal change disease

Question 11

What is the pathophysiology of minimal change disease?

Answer 11

podocyte fusion and effacement of the podocyte foot processes on renal biopsy.

Question 12

What are the causes of nephrotic syndrome in adults?

Answer 12

• Membranous nephropathy where immune complexes deposit in the glomerular basement membrane resulting in thickening and proteinuria -> histology shows IgA deposits and complement deposits
• HSP
• Diabetes
• Infection such as HIV

Question 13

What are the antibodies for Goodpasture, Microscopic polyangiitis and Granulomatosis with polyangiitis?

Answer 13

Anti-GBM - Goodpastures
p-ANCA - Microscopic polyangiitis
c-ANCA - granulomatosis with polyangiitis

Question 14

How are nephrotic/nephritis syndromes managed?

Answer 14

• Renal biopsy for histology
• Renal referral
• Supportive care including dialysis
• Immunosuppresion if needed