Nephritic Syndrome Clinical Features: • Glomerular haematuria • Hypertension • Mild proteinuria • Oedema • Reduced GFR Causes: • Autoimmune o IgAN o Anti-GBM Infection related e.g. post-strep o Mesangiocapillary GN o ANCA-associated vasculitis o • Inherited o Alport’s syndrome Assessment and Investigation • History: onset of symptoms, immune triggers (recent or current infection, medications exposure, etc.), other system symptoms • Exam: fluid status, BP, rashes (vasculitis) • Urinalysis: haematuria, mild proteinuria, • Investigations: autoantibodies (e.g. anti-GBM) and immune components (e.g. complement proteins), test for active or recent infections (e.g. Hep B/C), kidney biopsy Degenerative Glomerular Diseases • Normal ageing  progressive loss of GFR to: Vascular injury o Glomerular scarring (glomerulosclerosis) o  Global or segmental  Including secondary FSGS (hyperfiltration) • Main clinical manifestation is loss of GFR o Proteinuria minimal o Haematuria uncommon as glomerular filtration barrier is not injured in remaining glomeruli Hyperfiltration/Secondary FSGS • Distinct pathological injury pattern o Focal: patchy glomerular involvement o Segmental: partial involvement within the glomerulus o Sclerosis: fibrotic scarring • Mechanism Intracapillary hypertension  sclerosis of glomerular capillary loops o Progressive loss of glomeruli leads to hyperfiltration in other glomeruli o This leads to progressive renal injury o Accelerated by any cause of renal injury or loss of function o Sometimes called hyperfiltration glomerulosclerosis o Contributes to GFR reduction after reversible injury o Manifests as albuminuria and declining GFR o Genetic Glomerular Diseases • Alport’s syndrome o X-linked o Abnormal collagen component of GBM o Clinical manifestations:  Glomerular haematuria and proteinuria  Progressive GFR loss (chronic renal failure)  Deafness and ocular abnormalities due to systemic abnormal collagen • Familial FSGS o Usually single gene defect in podocyte proteins o Usually associated with non-nephrotic proteinuria and progressive CKD