nephritic syndrome Flashcards
what does the site of the glomerular injury have to do with the presentation of nephritic or nephrotic ?
podocyte injury is associated with protein loss only
endothelial and mesangial cells are associated with nephritic syndrome
what are the major causes of the nephritic syndrome ?
post streptococcal
IgA nephropathy
diffuse proliferative
Rapidly progressive
Alports syndrome
Memebranoproliferative GN ( could do both )
when does post strep GN happen ?
after a group A beta hemolytic strep infection , either presenting as impetigo or pharyngitis
what is the pathophysiology associated with post strep GN ?
immune complex deposits on the GBM - which are C3, IgM and IgG
associated with hypocomplementemia
what is the appearance of post strep GN in light microscopy vs in immunofluorescence vs electron microscopy?
light - enlarged and hypercellular glomeruli due to inflammation
immunofluorescence - granular , starry night appearance or lumpy bumpy
electron microscopy - subepithelial iC lumps
what is the classic case associated with post strep GN ?
child
2-3 weeks after a strep throat infection
develops nephritic syndrome
what is the hallmark of post step GN on electron microscopy ?
subepithelial humps
what is the prognosis of post strep GN ?
better prognosis in children
worse in adults - can develop RPGN
what is the other name for IgA nephropathy and what is the common presentation ?
bergers disease
IgA deposition in the mesangium , caused by viral infections presents 2-3 days after onset of illness
usually a UI or GI illness
what is the underlying problem associated with IgA nephropathy ?
an overactive immune system
what is the classic presentation associated with IgA nephropathy ?
occurs concorruently with respiratory or GI infections
what is the appearance on light microscopy vs immunofluorescence vs electron microscopy for IgA nephropathy ?
light microscopy - mesangial proliferation
immunofluoresence - IgA based IC in the mesangium granular appearance
electron microscopy - mesangial IgA deposition
what is the classic case associated with IgA nephropathy ?
recurrent episodes of hematuria since childhood
episodes come after URI or diarrheal illnesses
slowly worsening renal function over time
what is the difference in the onset of illness between IgA nephropathy and post strep GN ?
post strep - GN : weeks after infection
IgA GN : days after infection
what ttype of vasculitis is associated with IgA nephropathy ?
henoch schonlein purpura
what is the mechanism associated with DPGN ?
diffuse proliferative GN
often due to SLE , often presents with other SLE features : fever rash and arthritis
what is the most common form of lupus nephritis in SLE patients ?
diffuse proliferative GN
what is the appearance of diffuse proliferative in light microscopy vs immunoflouresence vs electron microscopy ?
light microscopy - wire looping ( capillary loops are thickened)
immuno - granular appearance
electron : subendothelial sometimes subepithelial or intra membranous IgG based IC with C3 depositions ( gives a full house pattern)
what is the presentation of diffuse proliferative glomerulonephritis ?
mixed clinical presentation
can present with both proteinuria and hematuria
what is the other name for rapidly progressive GN ?
cresenteric GN
what type of HS is post strep GN vs cresenteric GN ?
post strep - is a type 3 HS
cresenteric is - is a type 2 HSR
what is the presentation of RPGN ?
acute deterioration of renal function in the setting of vasculitis
they present with fatigue and anorexia
what is seen on light microscopy vs immuno vs electron microscopy in RPGN ?
light : crescent moon shape consists of plasma proteins and fibrin
immuno : linear IF due to antibodies in the GBM
what are the three different types of RPGN ?
type 1 : anti GBM disease linear along the GBM
type 2 : immune complex mediated bumpy or granular
type 3 : pauci immune barley anything there
