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Glomerulonephritis

Nephritic Syndrome
1. Haematuria / Proteiurina <3g/24hrs / HTN / Oliguria
2. IgA nephropathy
  1. IgA immune complex in glomeruli / Occurs 1-2 days after febrile illness
  2. Dx: Urine: RBC casts /Tissue biopsy: IgA and complement deposits
    1. Biopsy looks like HSP (also IgA mediated)
  3. Tx: If normal renal function / BP - no tx. If yes - corticosteroids +/- IS
3. Rapidly Progressive GN
  1. Can cause renal failure in weeks to months
  2. Tx: Corticosteroids +/- immunosuppression. Anti-GBM - plasmapheresis
  3. Categories
    1. Anti-GBM (Goodpasture's) - can cause renal-pulmonary syndrome
    2. Immune complex e.g. Infectious - post-strep / bac endocaridits / Hep B. SLE / IgA
    3. Pauci-immune - ANCA +ve vasculitis
  4. Sx: Nephritic syndrome / Generalised symptoms
  5. Dx: Identify cause - serology / immunostaining / biopsy
4. Tx: HTN - ACEI / oedema - fluid restrict / Steroids +/- IS
5. Post-infectious GN
  1. 1-2 weeks post streptococcal infection (pharyngitis / impetigo)
  2. Bacterial antigens bind to glomerulus and attract immune response
  3. Dx: Urinalysis - RBC casts/ ASO titre +ve/ Bloods: Low complement levels/ Biopsy - WC infiltration
  4. Tx: Supportive / dialysis if serious
Nephrotic syndrome
1. Proteinuria >3g/24hrs / Hypoalbuminaemia / Oedema
2. Tx: Proteinuria - ACEI / Oedema -Na+ restriction / diuretics
3. Primary Causes
  1. Minimal change nephropathy
    1. Seen in Children. Responds very well to steroids
    2. Clinical Dx, normal renal function and biopsy
  2. Focal Segmental GN
    1. Ax: Idiopathic / 2ry to HIV / drugs / SLE / SCD
    2. Dx: Tissue biopsy / Immuno: IgM complexes and complement
    3. Young black males
    4. Tx: underlying cause / ACEI / steroids
  3. Membranous GN
    1. Ax: Immune complexes 1ry - idiopathic / 2ry to Drugs / infections / SLE / CANCER
    2. Tx: Treat cause / steroids +/- IS
    3. Dx: Tissue biopsy - immune complexes
4. Secondary causes
  1. Diabetes / amyloidosis / Haematological malignancies / infections / preeclampsia
Mixed Nephritic - Nephrotic
1. Haematuria / Proteinuria >3g/day
2. Lupus Nephritis
  1. Immune complex mediated - nuclear antigens and anti-dsDNA abx
  2. Dx: SLE diagnosis - antidsDNA +ve. Biopsy
  3. Can lead to RPGN
  4. Tx: Cortiocsteroids +/- IS (treat SLE). Treat HTN with ACEI
3. Membranoproliferative GN
  1. Type I - proliferation + immune deposits - 2ry to SLE / chronic infection - bacterial endocarditis / HIV / Hep B&C / Cancer
    1. Type II - Complement mediated - C3 nephritic factor (anti C3 convertase)
  2. Dx: Bloods - low complement. Look for 2ry causes - infection / SLE. Renal biopsy
  3. Tx: Steroids

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Glomerulonephritis

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	Created by Louis Darby over 6 years ago