Glomerulonephritis

Nephrotic and nephritic are two of the common presentation for disorders of the glomerulus. 

Nephrotic syndrome 

Summary: loss of protein through kidneys

• Aetiology

  • Primary causes: 

    1. Most common in adults: Membranous Nephropathy 

    2. Most common in children: Minimal Change Disease 

       •  Focal Segmental Glomerulosclerosis (FSGS),  Diabetic nephropathy

  • Secondary causes of primary processes:  Amyloidosis , Systemic Lupus Erythematous , HIV , NSAIDs

• Presentation: unexplained fluid overload

• Diagnosis

  • 1. Proteinuria 

    2. Hypoalbuminaemia, 

    3. Peripheral oedema, 

       • Further signs: hyperlipidaemia, thrombotic events

• Management

  • • Duiretics (furosemide)

    • Anticoagulation (deficiencies in clotting factors, particularly factor S and anti-thrombin III)

    • Statins (hyperlipidaemia)

    • ACE inhibitors (proteinuria)

    • Kidney biopsy & treatment underlying cause

    • Low to medium protein diet

Notes

• Creatinine & eGFR can be normal in nephrotic syndrome

• A 24hr urinary albumin: creatinine ratio can be a helpful screening test

• Nephrotic syndrome can have haematuria, haematuria is not diagnostic of nephritic syndrome. 

• There is a lack of evidence for replacing albumin, be may cause benefit

Nephritic syndrome 

Summary: loss of blood as a sign of kidney damage

• Aetiology

  • • Poststreptococcal Glomerulonephritis : commonest in children, two weeks post URTI

    • IgA Nephropathy : 2 dAAAys after URTI

    • Crescent or rapidly progressive glomerulonephritis (RPGN) is a type of rapid nephritic syndrome caused by:

      • • Goodpasture's Disease 

        • IgA Nephropathy , HSP 

        • Systemic Lupus Erythematous 

• Diagnosis: haematuria, hypertension, oliguria and oedema

• Management

  • • Investigate for underlying cause: ?Corticosteroids ?DMARDs

    • Anti-hypertensives

    • Restrict sodium/ fluid

    • Diuretics

    • Dialysis if required

References

1. Tapia C, Bashir K. Nephrotic Syndrome. [Updated 2023 May 29]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK470444/

2. Hashmi MS, Pandey J. Nephritic Syndrome. [Updated 2023 Aug 8]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK562240/

3. https://stanfordhealthcare.org/content/dam/SHC/health-care-professionals/medical-staff/medstaff-weekly/20170315-guidelines-for-intravenous-albumin-administration.pdf

4. https://medcal.mvm.ed.ac.uk/wp/renal/the-spectrum-of-glomerulonephritis/ as part of https://medcal.mvm.ed.ac.uk/wp/renal/ 

Page written in 2024.