Glomerulonephropathy

Nephritic- proliferativeor

Nephrotic- non-proliferative

Nephritic or Nephrotic Proteinuria mostly

<3.5 gm per day Hematuria Active urine

sediment- RBC cast HT- common Uremia- common PSGN, RPGN

Nephrotic range- >3.5 gm per day

Not seen Bland urine

sediment Uncommon Uncommon MCD, membranous

nephropathy

IgA nephropathy Commonest glomerulonephritis IgA deposition in glomerular mesangium,

seen in kidney biopsy More in young adults, males>females Gross or microscopic hematuria,

frequently associated with URI ~50% have progressive renal insufficiency Rx- ACEI to reduce proteinuria Steroids, if proteinuria >1 gm/day Renal transplantation (recurrence in ~30%)

Post-streptococcal GN- PSGN Follows infection with type 12 group A

β–hemolytic streptococci Onset ~1-3 weeks after infection s/s- oliguria, hematuria, edema, HT Serum ASO titres- raised Biopsy- diffuse proliferative

glomerulonephritis Rx- supportive, with appropriate antibiotics Px- good in children, adults can have RPGN

or progressive CRI

Rapidly progressive GN- RPGN Rapid progression to renal insufficiency, over

few days to weeks Urine- active sediment Kidney biopsy- crescentic glomerulonephritis Types- I- anti-GBM- Goodpasture syndrome II- immune-complex mediated III- pauci-immune or ANCA associated

Goodpasture syndrome Glomerulonephritis with pulmonary hemorrhage Mediated by anti-GBM antibodies Males > Females, in 2nd-3rd decade Preceded by URI in ~50% s/s- edema, HT, oliguria, hemoptysis, dyspnea Ix- Sputum- hemosiderin laden macrophages CxR- fleeting pulmonary infiltrates- pulmonary hemorrhage Deranged RFT Anti-GBM antibodies in serum Rx- plasmapheresis,

with steroids & Cyclophosphamide

Immune-complex mediated GN Seen with SLE, EMC, IE, shunt nephritis Due to trapped immune-complexes in

subendo/epithelium or mesangium Clinical features of underlying disease, with

rapidly progressive renal dysfunction Kidney biopsy shows crescentic GN Rx- of underlying disease, with pulse steroids

or Cyclophosphamide ± plasmapheresis

Pauci-immune GN Seen with Wegener’s granulomatosis, Churg-Strauss

disease, microscopic polyangiitis s/s- fever, malaise, respiratory symptoms,

edema, HT, hematuria, oliguria Ix- Urine- active sediment RFT- deranged CxR- nodular infiltrates of Wegener’s ANCA- C-ANCA- antiproteinase 3, P-ANCA- antimyeloperoxidase Rx- oral steroids with pulse Cyclophosphamide

(Azathioprine/mycophenolate)