Nephritic Syndrome

Question 1

Key features of nephritic syndrome:

Answer 1

Hematuria, RBC casts

Increased BUN, creatinine, azotemia
Oligouria
Hypertension

Question 2

Pathology of nephritic syndrome:

Answer 2

GBM disruption, inflammatory process

Question 3

Six common nephritic syndrome causing disease patterns:

Answer 3

Acute poststreptococcal glomerulonephritis
Rapidly progressive (Crecentic) glomerulonephritis
IgA nephropathy (Berger disease)
Alport Syndrome
Membranoproliferative glomerulonephritis (MPGN)

Diffuse proliferative glomerulonephritis: caused by SLE or MPGN

Question 4

Pathology changes seen with Acute Poststreptococcal Glomerulonephritis

Answer 4

LM (light microscopy): enlarged hypercellular glomeruli

IF (immunoflourescence): “starry sky” - granular due to IgG, IgM and C3 deposition along GBM and masangium.

EM (electron microscopy): subepithelial immune complex humps.

Question 5

Demographics of Acute Poststreptococcal Glomerulonephritis

Answer 5

kids, 2-4 weeks after Group A Strep infection

Question 6

Presentation, labs, and prognosis of Acute Poststreptococcal Glomerulonephritis

Answer 6

Peripheral and periorbital edema, cola-colored urine, HTN.
Labs: positive strep titer, decreased complement leves due to consumption.
Resolves spontaneously.

Question 7

Pathology changes seen with Rapidly progressive (Crecentic) glomerulonephritis

Answer 7

LM and IF: crescents - consist of fibrin and plasma proteins with monocytes, macrophages, and glomerular parietal cells.

Question 8

3 Diseases causing Rapidly Progressive (Crecentic) Glomerulonephritis pattern

Answer 8

1. Goodpasture Syndrome: Type II hypersensitivity, antibodies form against GBM and alveolar BM
2. Granulomatosis with polyangitis (Wagner)
3. Microscopic Polyangitis

Question 9

Pathology changes of Goodpasture Syndrome ___
Presentation ___
Treatment ___

Answer 9

Pathology: IF: Linear cresents
Presentation: hematuria/hemoptysis
Treatment: emergent plasmopheresis

Question 10

Pathology changes of Granulomatosis with Polyangitis (Wagner)____

Labs___

Answer 10

Path: Pauci-immune so no Ig or C3 deposition
Labs: PR3-ANCA/c-ANCA elevated

Question 11

Pathology changes of Microscopic Polyangitis__

Labs___

Answer 11

Path: Pauci-immune so no Ig or C3 deposition

Labs: MPO-ANCA/p-ANCA

Question 12

Prognosis of diseases causing Rapidly Progressive (Crecentic) Glomerulonephritis pattern

Answer 12

Poor. Rapidly deteriorating renal function: days -weeks.