Nephritic Syndrome Flashcards
What else does nephritic syndrome pResent with?
LAHHOR
Limited protein urea <3.5 g/day
Azotaemia
Hypertension = salt + fluid retention = oedema = at eyes as little bit of oedema that does occur particularly shows itself + loose connective tissue
Hyper cellular - neutrophils
Oliguria
RBC casts - glomerular bleeding + hematuria
What is the hallmark of nephritic syndrome?
Glomerular inflammation
Glomerulal bleeding
What is special about the strain that causes poststreptococcal glomerular nephritis?
Where does immune complex deposition start and how does it progress?
The nephritogenic strains = carry M protein virulence factor
IC start subendothelial – > Work their way up – >
pile of subepithelially – >
deposit into space + disappear
When and What do patients with poststreptococcal glomerular nephritis present with?
HSR3 2-3 wks after infection
Haematuria = cola colour urine
Hypertension,
oliguria,
periorbital oedema
For poststreptococcal glomerular nephritis what do we see on
light microscopy
immunofluorescence and
electronmicroscopy
@LM here = hypercellular + inflamed/enlarged glomerulus
@IF = granular IF
@EM = subepithelial hump
What’s the labeork for PSGN?
What is the treatment for Poststreptococcal glomerulal nephritis
⬆️anti-DNase B titers + ⬇️ complement levels
Csupportive
@Kids = rarely progressed renal failure
At adults develop renal failure = rapidly progressive glomerular nephritis
What does the biopsy in a rapidly progressive glomerulonephritis show?
@LM + IF =
Crescent moon shaped
|
|-> fibrins + plasma protein eg C3b
Macrophages +
Glomerulal parietal cells +
Monocytes
YOUNG ADULT Patient
presents with
LINEAR immunofluorescence , Haemoptysis, hematuria
What does he have and explain the IF
Goodpasture’s syndrome
Type 2HSR - anti-basement membrane antibody against basement membrane
Alveolar +
glomerular basement membrane = sharp line
In Lupus what is the most common cause of death?
Renal failure - diffuse proliferative glomerulonephritis
If a patient with lupus presents with a nephrotic syndrome which nephrotic syndrome will it be?
Membranous nephropathy
Patients has crescent moon shaped Glomerulitis With a GRANULAR immunofluorescence. What’s is the DDX?
Post strep glomerular nephritis
Diffuse proliferative glomerulonephritis i.e. deposits immunocomplex underneath endothelial cell = subendothelial = Lupus
Patient has crescent moon shaped glomerulitis
A negative immunofluorescence = PAUCI immune . What test needs to be performed after this
ANCA Anti neutrophil cytoplasmic antibody
patient has haemoptysis + haematuria + rapidly progressive glomerulal nephritis .Patient has crescent moon shaped glomerulitis. The patient has a history of sinus problems and has sinusitis. What’s does he have ?
Where can I granulomatosis.
It’s not Goodpasture because Goodpasture does not have naso pharynx problems
Patient would also have A negative immunofluorescence = PAUCI immune. Has a c-ANCA…..!!!!! Goodpasture has linear IF
patient has haemoptysis + haematuria + rapidly progressive glomerulal nephritis .Patient has crescent moon shaped glomerulitis. A negative immunofluorescence = PAUCI immune. Has a p-ANCA. What’s the DDX?
Microscopic polyangiitis doesn’t have the things mentioned below
Churg Strauss =
Asthma
granulomatous inflammation
eosinophilia
patient has haemoptysis + haematuria + rapidly progressive glomerulal nephritis .Patient has crescent moon shaped glomerulitis. A negative immunofluorescence = PAUCI immune. Has a p-ANCA. Patient has asthma, granulomatous information, eosinophilia. What is it
Churg Strauss
What is the most common at nephropathy worldwide
Explain how mucosa infection leads to IgA nephropathy
IgA nephropathy
Mucosal infection = produce XS IgA to defend against mucosal infection – >
some IgA goes to mesangium + deposit as immune complex –>
glomerular bleeding = episodic gross/microscopic hematuria
HENLOCH SCHONLEIN PURPURA
In Ig a nephropathy where are the immunocomplexes deposited?
Mesangium of glomeruli
A patient with a type 4 collagen issue comes in and says he cannot see, cannot pee, cannot hear a buzzing bee.
The electromicroscopy revealed a Basketweave appearance.
what problem does he have
Alport syndrome = thinning + splitting of basement membrane
What causes diffuse proliferative glomerular nephritis?
SLE1 membranoproliferative glomerular nephritis
What does light microscopy
Electromicroscopy
Immunofluorescence show
In diffuse proliferative glomerulonephritis?
LM = wire looping of capillaries
EM =
subendothelial +
intramembranous IgG IC’s +
C3 deposition
IF=granular
What Diseases often present is nephrotic and nephritic syndrome concurrently?
Diffuse proliferative glomerular nephritis
Membranous proliferative glomerulonephritis
Explain pathogenesis of Alport syndrome
Inherited type 4 collagen – >
thinning + splitting on BM – >
Isolated hematuria only
+
BM @ ears = damaged = sensory hearing loss
BM @ eye = damaged = ocular disturbance
What does electron microscopy reveal for Alport syndrome
Basket weave appearance
