Nephritic Syndromes

Question 1

Acute Post-streptococcal Glomerulonephritis

Answer 1

epi: seen in children, 2 weeks after a GAS infection of the pharynx or the skin (impetigo)-
- Type 3 Hypersensitivity reaction
Sx: hypertension, periorbital and peripheral edema, cola-coloured urine
inc. Anti-DNAase titers, and dec. in complement levels (because the antibody-antigen complex is fixing the complement)
LM: hypercellular enlarged glomeruli
IF: Starry sky appearance- do due deposition of the IgM, IgG and C3 in the GBM and the mesangium
EM: subepithelial immune complex humps

Question 2

Rapidly Progressive Glomerulonephritis

Answer 2

Crescentic
LM and IF: crescent shape in the glomerulus - consist of fibrin, plasma proteins (C3B) with glomerulus parietal cells, monocytes and macrophages
Rapidly progressive
Disease examplees :
1. Good pastures syndrome- type 2 hypersensitivity
2. microscopic polyangitis
3. granulomatosis with polyangititis

Question 3

Diffuse Proliferative Glomerulonephritis

Answer 3

Due to SLE or membranoproliferative glomerulonephritis
presents as a nephritic- nephrotic syndrome
LM: wire looping of capillaries
EM: sub endothelial and intramembraneous IgG based IC’s often with C3 deposition
IF: granular

Question 4

Membranoproliferative Glomerulonephritis

Answer 4

Nephritic syndrome that presentss with nephrotic syndrome as well
Type I- due to hep B or C infection, or idiopathic
- subendothelial immune complex deposits with granular IF
- tram-track appearance on PAS stain and H&E stain due to GBM splitting caused by mesangial ingrowth
Type 2: associated with C3 nephritic factor (stabilizes C3 convertase- dec. serum C3 levels)
- intramembraneous IC deposits; dense deposits

Question 5

IgA nephropathy

Answer 5

Episodic hematuria with RBC casts- Presents with renal insufficiency or acute gastroenteritis
LM: mesangial proliferation
EM: mesanial IC deposits
IF: IgA based IC deposits in mesangium
* renal patholgy of henoch-schonlein purpura

Question 6

Alport syndrome

Answer 6

Mutation in type IV collagen- thinning and splitting of the glomerular basement membrane
associated with eye problems (retinopathy, lens dislocation), sensorineural deafness,
Basket weave appearance on EM

Question 7

Nephritic syndrome

Answer 7

Damage to the GBM - inflammatory process
SX: hypertension, Inc. BUN (azotemia) and CR, oliguria, hematuria, RBC casts.
- proteinuria