17 Nephritic Syndrome

  • increased hydrostatic pressure in rest of body
  • GFR low: The glomeruli are stuffed full of cells, and blood flow slows way down.

  • uremia: aka azotemia

Causes

  • membranoproliferative: either nephritic or nephrotic

PSGN

  • deplete complements

  • rheumatic fever: master chef with M
  • PSGN: post strep glomerulonephritis: chef on phone
  • Facial puffs: Facial swelling seen in PSGN
  • Cola: Cola colored urine with PSGN
  • Calendar: PSGN occurs 2 weeks after Strep infection
  • Pencil: Early penicillin for treatment (prevents RF but not PSGN). Even though chef has pencil, he still has symptoms
  • PSGN, lupus, MPGN

  • takes time for immune system

  • hypercellular: inflammation related

  • bumpy appearance because in endothelium

  • worked their way into sub epithelium

IgA

  • IgA usually does not activate complement but does here
  • weak complement activation, thus no hypocomplementemia

  • IgA stain, like branches of tree

HS Purpura

  • IgA deposition in joints, GI
  • IF stain granular

  • complement activated via alternative/lectin pathway. IgA does not fix complement

  • biopsy shows IgA deposition

DPGN

  • type 1/2: mild; 3-5 serious
  • focal: <50% glomerulus involved

  • immune response from anti-dsDNA

  • can be nephrotic, nephritic

RPGN

  • RPGN: common pattern of inflammation in glomeruli representing many diseases
  • quickly progress to RF

  • elevated BUN:Cr

RPGN Type I

  • not bumpy

RPGN Type II

RPGN type III

  • Pauci-immune: no immune staining

Alport

  • male child with triad
  • Electron microscopy of a renal biopsy shows irregular thinning of the glomerular basement membrane (GBM) with splitting/lamination of the lamina densa, giving the GBM a unique “basketweave” appearance.