L1 - 2 Glomerulonephritis

Glomerulonephritis (GN)

Classification

• Primary: Idiopathic or Hereditary (e.g., Alport’s Syndrome - associated with hearing loss).
• Secondary:
• • Infections: Post-strept (most common), Hepatitis B, C, HIV.
  • فيروس B: يرتبط بشكل أساسي بـ Membranous Nephropathy،،.
  • فيروس C: يرتبط بـ Mesangio-proliferative GN وأيضاً بـ Cryoglobulinemia،،

  
  

  • Drugs: NSAIDs, Sulfa, Penicillin.
  • Metabolic: Diabetes Mellitus (Most common cause of Renal Failure - 📝MCQ).
  • Immune: SLE, Vasculitis, Rheumatoid Arthritis.

Clinical Presentation: The "Ahli vs. Zamalek" Analogy

1. Nephritic Syndrome (The "Red Team" - Hematuria):
2. • Hematuria (Main feature), HTN, Oliguria, Mild proteinuria.
   • Causes: Post-strept GN, IgA Nephropathy, Lupus Nephritis, Wegener’s.
2. Nephrotic Syndrome (The "White Team" - Proteinuria):
3. • Massive Proteinuria (>3.5g/day), Hypoalbuminemia, Severe Edema, Hyperlipidemia.
   • 📝MCQ/⭐️Important: Hypercoagulability (Thrombotic tendency) is a major risk in Nephrotic patients due to loss of clotting factors.
   • Causes: Minimal Change (children), Membranous (Adults), Focal Segmental (HIV/Obesity).

Low Complement Levels (⭐️Important/📝MCQ)

Dr. Hassan highlighted that low serum complement (C3/C4) is a classic exam question. Causes include:

1. SLE (Lupus Nephritis).
2. Post-Streptococcal GN.
3. MPGN (Membrano-proliferative GN).
4. Cryoglobulinemia (Type 2).
5. Note: IgA Nephropathy typically has NORMAL complement levels.

VII. Specific GN Diseases

1. IgA Nephropathy (Berger’s Disease)

• Presentation: Synpharyngitic Hematuria (Hematuria occurring during or immediately after an upper respiratory infection).
• 📝MCQ: Contrast this with Post-strept GN, which has a latent period (1-3 weeks) after infection.
• Prognosis: Usually benign, but poor if the patient is a smoker or has high proteinuria (>2g).

2. Goodpasture Syndrome (Anti-GBM)

• Pathology: Antibodies against the basement membrane in both lungs and kidneys.
• Presentation: Hemoptysis (coughing blood) + Hematuria.
• Management: Steroids, Cyclophosphamide, and Plasmapheresis (to remove antibodies).

VIII. Management Principles

• General: Salt restriction, controlling BP using ACE inhibitors or ARBs (to reduce proteinuria).
• Immunosuppression: Steroids (to block mechanisms and accelerate recovery), Cyclophosphamide (to stop antibody formation).
• Emergency: Dialysis (Renal Replacement Therapy) for hyperkalemia, severe acidosis, or fluid overload.
• Long-term: Renal Transplantation for eligible candidates.