1. Ben Savage

2.  Overview
 Causes
 Investigation
 Types
◦ Non Proliferative
◦ Proliferative
◦ Chronic

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.  Cardinal symptoms:
 Proteinuria
 Haematuria
 Urinary Casts
 Also presents with
◦ ARF or CRF
◦ Nephrotic or Nephritic syndrome
◦ Proteinuria & HTN

5.  Primary
 2ry association with:
• Wegener granulomatosis and other vasculitides
• SLE
• Certain infections (e.g Streptococcus pyogenes)
• DM
• Drugs

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.  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. ◦ 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. ◦ 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.  Characterised by increased number of cells in
the glomerulus (hypercellular)
 Present as a Nephritic syndrome and can
lead to ESRF

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. ◦ Post-infectious GN
 Can occur after any infection; most common Strep
Pyogenes
 Treatment is supportive
 Generally resolves in 2–4 weeks.

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.  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.  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. Any Question