W1L5 Nephritic Syndrome

Question 1

Pathophysiologic?

Answer 1

Nephritic syndrome occurs as a result of inflammatory damage to renal endothelium

Question 2

CLINICAL MANIFESTATIONS?

Answer 2

i. Glomerular hematuria and pyuria
ii. Proteinuria
iii. Renal dysfunction
iv. Hypertension & edema

Question 3

Terminology

Answer 3

Acute GN- acute
RPGN- GFR reduce over day-week
Chronic GN- month-years

Question 4

CAUSES OF ACUTE NEPHRITIC SYNDROME?

Answer 4

a. Immune complex disease
b. Pauci-immune disease
c. Anti-GBM–associated diseases

Question 5

IMMUNE COMPLEX DISEASES?

Answer 5

I. SYSTEMIC DISEASES

• Postinfectious GN
• SLE
• Subacute bacterial endocarditis
• Hepatitis C
• IgA nephropathy (Berger’s disease)

Question 6

causes of hypocomplementemic nephritic syndrome?

Answer 6

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• SLE
• Subacute bacterial endocarditis
• Shunt nephritis
• Cryoglobulinemia(hepatitis C)
• Postinfectious GN
• MPGN

Question 7

RENAL CAUSES?

Answer 7

MPGN:
Type I (most common usually subendothelial deposits)
Type II (dense deposit disease-higher incidence hypocomplementemia)
Type III (prominent subepithelial and subendothelial deposits)

Question 8

PAUCIIMMUNE DISEASES?

Answer 8

i. Small vessel vasculitis syndromes

ii. Primary ANCA-associated GN

Question 9

ANTI-GBM–ASSOCIATED DISEASES?

Answer 9

i. Systemic diseases(Goodpasture’s syndrome)

ii. Renal disease

Question 10

APPROACH TO THE PATIENT?

Answer 10

a. Diagnosis
- fresh urine
b. Categorize GN
- lab test(serum C3&4)
- renal biopsy(definitive)

Question 11

TREATMENT?

Answer 11

a. Inflammatory renal disorders
- immunosuppressive agents

b. Indications for hemodialysis
- uremic,acidotic,hyperkalemic

c. The patient’s electrolyte status
- BUN, creatinie, bp