Nephritic Syndromes

Question 1

What are the main features of nephritic syndromes?

Answer 1

protein in urine

Question 2

Acute post-strep glomerulonephritis…Describe the images on biopsy?

Answer 2

Light microscopy–glomeruli enlarged and hyper cellular and neutrophils up in there.
IF–lumpy bumpy IgG, IgM, C3 deposition along GBM and mesangium. GRANULAR
EM–subepithelial humps under podocytes

Question 3

What type of hypersensitivity reaction is acute post-strep glomerulonephritis? Common presentation? Would antibiotics at the time of strep infection prevent this?

Answer 3

Type III hypersensitivity
children, 2 weeks after strep pharyngitis or skin infection
cola-colored urine, edema
No, b/c autoimmune. But antibiotics do prevent acute rheumatic fever and heart dx.

Question 4

Which substances in blood indicate post-strep glomerulonephritis?

Answer 4

C3 decreased b/c consumed in deposition
anti-streptolysin O may be increased if after pharyngitis (but not skin infection)
in all types of strep infection–elevation anti-DNAse B

Question 5

What is the image of rapidly progressive glomerulonephritis?

Answer 5

crescent moon shape

deposits of fibrin and plasma proteins

Question 6

Which diseases can result in rapidly progressive glomerulonephritis?

Answer 6

Goodpasture–Type II (linear)
Wegener (granulomatosis w/ polyangitiis)
Microscopic polyangitiis

Question 7

What can help distinguish wegener from microscopic polyangitiis rapidly progressing glomerulonephritis?

Answer 7

Wegener–+c-ANCA (PR3-ANCA)

microscopic polyangitiis – + p-ANCA (MPO-ANCA)

Question 8

Diffuse proliferative glomerulonephritis is most often caused by what? What does it look like on biopsy?

Answer 8

SLE
Light micro: wire looping of capillaries
EM: subendothelial & intramembranous IgG and C3 deposits
IF–granular

Question 9

Which 2 types of nephritic syndromes can present w/ proteinuria>3.5 g lookin like nephrotic?

Answer 9

diffuse proliferative glomerulonephritis

membranoproliferative glomerulonephritis

Question 10

What does IgA nephropathy look like on biopsy?

Answer 10

LM: mesangial proliferation
EM: mesangial immune complexes
IF: IgA deposits in the mesangium.

Question 11

Which syndrome is IgA nephropathy a part of? Presentation?

Answer 11

often post-URI or post-gastroenteritis (places w/ IgA)

Henoch Schonlein Purpura

Question 12

What are the main features of Henoch Schonlein purpura?

Answer 12

IgA nephropathy
arthalgias
abdominal pain
purpura

Question 13

What are the main features of Alport syndrome?

Answer 13

can’t see, can’t pee, can’t hear high C.

X-linked disorder of Type IV collagen

Question 14

What does Alport syndrome look like w/ kidney biopsy?

Answer 14

splitting of the glomerular basement membrane

EM: basket-weave appearance