Glomerulonephritis

Overview

Glomerulonephritis is inflammation of the glomerulus.  Glomerulonephritis is classified by clinical syndrome/presentation (e.g. nephritic or nephrotic syndrome), histological appearance , or by aetiology. We will divide glomerulonephritis broadly into  two broad types: Nephritic glomerulonephritis and nephrotic glormerulonephritis.

Classification

Two Types of Glomerular disease:

• Nephrotic Syndrome
• Nephritic Syndrome

DIFFERENCE BETWEEN NEPHROTIC AND NEPHRITIS SYNDROME
	Nephrotic Syndrome	Nephritic Syndrome
Onset	Slow	Acute
Swelling	++++	++
Blood Pressure	Normal	Increased
Proteinuria	++++	++
Haematuria	+/-	+++
Red cell casts	Not present	Present
GFR	Normal	Normal/low
Serum albumin	Low	Normal/low
Serum lipids	High	Normal
Most commonc cause	Diabetic Nephropathy	IgA nephropathy

Approach

• History
• Examination
• Investigations
  • EUC
  • Urinalysis
  • Urine culture
  • Immunological
  • X-ray
  • CT
  • MRI
  • Renal biopsy

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Renal biopsy looks at the histology of glomerular disease

• Light microscopy – Useful for morphology, chronicity, and diagnosis.
• Immunofluorescence – Usually by immunofluorescence but also immunoperoxidase staining. Localizes immune reactants
• Electron lightmicroscopy – Examining cell and basement membrane structure and for characterizing glomerular deposits.