Glomerular Disease Flashcards
What are the features of acute nephritic syndrome?
- Dysmorphic RBC casts
- Sub-nephrotic proteinuria <3.5g/day
- HTN
- Edema
- Oliguria <400 ml/24hrs
- Macroscopic hematocrit
What pathological features we see in Rapidly Progressive Glomerulonephritis?
Crescent formation, which are proliferating epithelial cells and inflammatory infiltrates creating crescent shaped lesions in Bowman’s space
What are the 3 most important serologic test to order in patients with possible Nephritic syndrome?
- Anti-GBM
- ANCA both P and C
- Complements
What does the the Biopsy show in Anti-GBM disease (goodpasture)
Linear deposits of IgG and C3
What does the immunofluorescence of renal biopsy shows in Pauciimmune Glomerulonephritis?
The 2 Pauciiimune are the C-ANCA and P-ANCA
Biopsy shows sparse or absent IgG and C3 deposit is that is why they are called pauci-immune
What are the different names for P and C ANCA
C-ANCA is also called Proteinase 3 (PR3) ANCA
P-ANCA is also called Myeloperoxidase (MPO-ANCA)
What are the C and P ANCA disease
C-ANCA=Wegener’s
P-ANCA=
- Microscopic polyangitis, which is a necrotizing vasculitis involving multiple organs (lungs, kidneys, Joints, Skin)
- Eosinophilic Granulomatosis with polyangitis (Chung Strauss)
- Renal Limeted Glomerulonephritis
In what scenario do we see double positive ANCA (both P and C with high tiger MPO-Ab?
Drug induced Glomerulonephritis specifically:
- Hydralazine
- PTU
- Minocycline
- Levamisole
What are the immune complex Glomerulonephritis? And what does biopsy show?
Post-Infectious Glomerulonephritis
Membranoproliferative glomerulonephritis
Idiopathic proliferating Glomerulonephritis
Cryoglobulinemia
Lupus
Infective Endocarditis
Biopsy show Granular deposition of IgG and C3
What 2 immune complex glomerulonephritis cause Normal complement, Negative ANCA and Negative GBM disease?
What deposit is doe we see on biopsy
IgA Nephropathy
IgA Vasculitis (Henoch shloieen)
We see granular IgA and C3 deposit
What is the principle of treatment in glomerulonephritis?
- Pulse steroid is given for almost all glomerulonephritis followed by oral steroid for up to 8 weeks and then tapering
- If there is lung hemorrhage or severe renal failure plasma exchange is needed
How long is the latent period for post-infectious glomerulonephritis
Pharyngitis about 7-10 days after
Skin infection 2 weeks to 1 month after.
What does light microscopy show in post-infectious glomerulonephritis?
What additional serological test that can be ordered?
Other than skin and throat what other infections can cause it?
What is the treatment?
Light microscopy show Diffuse proliferating glomerulonephritis
ASO titer ( ASO titer is increased )
Other infections: Bacterial endocarditis, chronic suppurations infections, visceral abscesses
It is self limiting and recovers in 3-4 weeks so management is supportive and managing symptoms
Anti-GBM disease is autoantibodies against what? HOw is it different from Goodpasture’s
Ab against Alpha 3 chain of type 4 collagen of glomerular basement membrane
Goodpastures syndrome is Anti-GBM Nephritis and Lung Hemorrhage
Typical patients are young males that have recent URI, or newly start smoking, or have exposure to volatile hydrocarbons
What does light microscopy show in Goodpastures?
What does lung biopsy in patient with Goodpasture’s disease?
What is the treatment?
Light microscopy: Diffuse proliferating glomerulonephritis + necrotizing lesions in more than 50% of the glomeruli
Lung biopsy show Alveolar hemorrhage, hemosiderin-laden macrophages, and linear staining of IgG along the alveolar capillary basement membrane
Rx: Plasmapharesis to stabilize the RPGN; Steroid and Cyclophosphamide after
