Glomerulonephritis

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

Nephrotic syndrome 

Summary: loss of protein through kidneys

Tetrad: proteinuria & hypoalbuminaemia, peripheral oedema, hyperlipidaemia

• Aetiology

  • • Most common in adults: Membranous Nephropathy 

    • Most common in children: Minimal Change Disease 

    • More primary causes:  Focal Segmental Glomerulosclerosis (FSGS)  ,  Diabetic nephropathy

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

• Management

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

    • Statins (hyperlipidaemia)

    • ACE inhibitors (proteinuria)

    • Kidney biopsy & treatment underlying cause

Note the creatinine & eGFR can be normal in nephrotic syndrome. A 24hr urinary albumin: creatinine ratio can be a helpful screening test. Can have blood in urine and still be nephrotic syndrome- blood is not diagnostic of nephritic syndrome. 

Further notes

• High protein diet: can worsen, advise low to medium protein diet

• Albumin replacement: may benefit, lack of evidence

Nephritic syndrome 

Summary: loss of blood as a sign of kidney damage

Definition (4): haematuria, hypertension, oliguria and oedema

• 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 

• Management

  • • Anti-hypertensives, restrict sodium/ fluid

    • Diuretics

    • Corticosteroids

    • DMARDs

    • 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.