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Nephritic syndrome (acute nephritis) (Types (2) Henoch-Schonlein …
Nephritic syndrome
(acute nephritis)
Definition
Acute inflammation of
the glomerulus, often
causing haematuria
Epidemiology
Common post-infection
Aetiology
Autoimmune
SLE
Vasculitis
Anti-GBM disease
IgA nephropathy
HSP
Infection
Post-strep (pharyngitis)
Staph, mumps
HBV, HCV
Malaria
Schistosomiasis
Types
2) Henoch-Schonlein
purpura (HSP)
Clinical presentation
Purpuric, palpable rash on extensor surfaces
Polyarthritis and oedema
Fever
Haematuria
Abdominal pain
Haematemesis
Malaena
Diagnosis (clinical)
History: rash, haematuria, recent infection (URT)
Examination: petechial/purpuric rash on extensor legs
Investigations: obs (fever, may have HTN), urine (+++blood),
bloods (nil), USS KUB (nil), biopsy (same as IgA)
Pathophysiology
Systemic variant of IgA (post infectious)
Small vessel vasculitis, deposition of Ig
Can cause local skin vasculitis and bowel vasculitis,
leading to bowel ischemia
Management
Medical: anti-HTN, immunosuppression
Epidemiology
Children 3-10y
M>F
Complications
HTN
Ischemic bowel, ileus, intussusception
Orchitis
3) Anti-GBM
disease
Pathophysiology
Auto-Abs to type IV collagen in GBM, lung
Get nephritis, pulmonary haemorrhage
Clinical presentation
Asymptomatic
Haemoptysis
Haematuria
Epidemiology
RARE
Diagnosis
History: cough up blood, haematuria
Examination: often nil
Investigations: obs (may have HTN), urine (+++blood),
bloods (anti-GBM +ve), USS KUB (nil), biopsy (anti-GBM)
Management
Medical: steroids, cytotoxics, IV Ig, plasma exchange
1) IgA nephropathy
Pathophysiology
Infection at mucosal surgace (RTI, GIT)
immune IgA complexes deposit in GBM
Inflammation and damage
Clinical presentation
Asymptomatic
Episodic VH
Epidemiology
Commonest GN
Young males
Diagnosis
History: young male, VH after RTI
Examination: abdo (nil)
Investigations: ons (nil, may have HTN), urine (+++blood),
bloods (all nil), USS KUB (nil), biopsy (IgA, C3, mesangial cell prolif, schlerosis and atrophy)
Management
Medical: anti-HTN (ACEi), immunosuppression
4) Post-strep GN
Epidemiology
Rare in Western countries
Pathophysiology
Strep pharyngitis or skin infection 1-2wk prior
Strep antigen deposited in glomerulus
Anti-strep Abs attack glomerulus
Clinical presentation
Haematuria
Diagnosis
History: prev RTI/skin infection, haematuria
Examination: nil
Investigations: obs (may have HTN), urine (+++blood),
bloods (anti-strep Ab +ve, anti-DNAse B +ve, high C3),
biopsy (Ig deposits)
Management
Supportive care (self limiting)
5) Others
Secondary to other infections
or systemic immune disease .e.g SLE, PAN, GPA
Clinical
presentation
Asymptomatic
Haematuria
Rash
Arthritis
Diagnosis
Examination
Abdo exam
Often nil
Pain if acute bowel ischemia
Investigations
Urine
Dipstick (+++protein)
MCS (casts, RBCs), ACR (nil)
Bloods
FBC (anaemia, infection), CRP (infection/inflammation),
U+E, GFR, Cr (renal function), LFTs, clotting
Immune screen (ANA, ANCA, C3/C4, anti-GBM, anti-strep)
Viral screen (HBV, HCV, HIV)
Bedside
Obs (may have HTN)
Weight (may be fluid overloaded)
Imaging
USS KUB (nil)
Biopsy
Differentiates type of GN
History
FH
Renal disease
Autoimmune disease
SH
Living arrangements, occupation,
school/nursery, smoking, alcohol, diet
DH
Meds, allergies
PMH
Growth and development
Known medical conditions
PC/HPC
Haematuria, abdo pain, rashes,
haemoptysis, malaise/fatigue,
recent infections
Management
Conservative
Information, advice, support
Diet (salt restriction if HTN)
Medical
Steroids
Indication: acute inflammatory GN
Immunosuppressants
Indication: inflammatory GN maintenance/
relapse
Anti-HTN
Indication: HTN
E.g. ACEi