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Glomerular Nephritis

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Glomerular Nephritis

  1. 1. Ben Savage
  2. 2.  Overview  Causes  Investigation  Types ◦ Non Proliferative ◦ Proliferative ◦ Chronic
  3. 3.  Is a renal disease characterized by inflammation of the glomeruli, or small blood vessels in the kidneys  Affects both Kidneys symmetrically  Accounts for 1/3 of patients requiring dialysis or transplantation
  4. 4.  Cardinal symptoms:  Proteinuria  Haematuria  Urinary Casts  Also presents with ◦ ARF or CRF ◦ Nephrotic or Nephritic syndrome ◦ Proteinuria & HTN
  5. 5.  Primary  2ry association with: • Wegener granulomatosis and other vasculitides • SLE • Certain infections (e.g Streptococcus pyogenes) • DM • Drugs
  6. 6.  Investigations: ◦ Bloods including – ANCA, Anti-GBM, ANF, C3/4 etc ◦ Renal USS ◦ Blood cultures ◦ Biopsy (providing kidney is not to small)  Diagnosis of underlying cause is crucial for determining prognosis and therapy
  7. 7.  This is characterised by lack of hypercellularity in the glomeruli.  Usually cause Nephrotic syndrome. ◦ Minimal change  Causes 80% of nephrotic syndrome in children, but only 20% in adult  Rx- Supportive care for oedema & steroids
  8. 8. ◦ Focal Segmental Glomerulosclerosis (FSGS) o Primary or Secondary to:  Reflux nephropathy, Alport syndrome, HIV or heroin use. o Presents as a nephrotic syndrome with varying degrees of impaired renal function o Steroids are tried but not shown to be affective o 50% of patients with FSGS have progressive renal failure
  9. 9. ◦ Membranous glomerulonephritis (MGN) o Common type of GN in adults, o Frequently produces a mixed nephrotic and nephritic picture o Usually idiopathic but can be secondary to:  Cancer, infection (malaria, hepatitis), drugs, CTD (SLE) o Prognosis is rule of 1/3 • 1/3 remit – 1/3 remain with MGN – 1/3 progress to end- stage renal failure (ESRF) o Treatment with corticosteroids
  10. 10.  Characterised by increased number of cells in the glomerulus (hypercellular)  Present as a Nephritic syndrome and can lead to ESRF
  11. 11. ◦ IgA nephropathy (Berger's disease)  most common type of glomerulonephritis in adults  It usually presents as macroscopic haematuria  Often affects young males within 24-48hrs after an upper respiratory tract or gastrointestinal infection  ACE inhibitors are the mainstay of treatment.  Prognosis is variable, 20% progress to ESRF
  12. 12. ◦ Post-infectious GN  Can occur after any infection; most common Strep Pyogenes  Treatment is supportive  Generally resolves in 2–4 weeks.
  13. 13. ◦ Rapidly progressive GN  Can be due to any type of GN  Poor prognosis progression to renal failure in weeks  Medical emergency and early intervention crucial  Treat with aggressive immunosuppression, blood pressure treatment and control of lipids.
  14. 14.  Patient present with: • chronic renal failure • Small shrunken kidneys • Chronic glomerulosclerosis and fibrotic changes  Pathological process usually burnt out and does not respond to therapy
  15. 15.  Accounts for 1/3 of patients requiring dialysis or transplantation  Multiple presentations  Non Proliferative usually nephrotic  Proliferative usually nephritic  Rapidly progressive GN is a medical emergency
  16. 16. Any Question

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