Glomerular Hematuria: Nephritic Syndrome Flashcards
classic triad of nephritic syndrome. What can it be complicated by?
- active urine
- hypertension
- acute kidney injury
- can be complicated by:
Complications
ESRD or CKD
Hypertension Associated
Other systemic disease specific manifestations
Complications of proteinuria
can you be nephritic and nephrotic at the same time?
yes. nephitic TRUMPS nephrotic in this case, and we puruse a NEPHRITIC diagnostic and treatment approach
Nephritic syndrome = RPGN = __ __ kidney injury
(sAKI).
acute renal failure is onset within :
chronic renal failure onsets/is present for at least __ months
Nephritic syndrome = RPGN (rapidly progressing glomerular nephritis)= Sub acute kidney injury
(sAKI)
Sub acute = in between acute and chronic
acute renal failure is onset within : hours to days
chronic renal failure onsets/is present for at least 3 months
DDx of sub acute kidney injury
- RPGN caused by nephritic syndrome
- cast nephropathy (myeloma kidney)
- obstruction
- cholesterol embolic disease
approach to sAKI:
can be broken down to 2 broad categories; __ secondary to nephritic syndrome, or __ where you could see casts or __ emboli.
__ secondary to nephritic syndrome is due to either __ GN or __ proliferation.
can be broken down to 2 broad categories; RPGN secondary to nephritic syndrome, or obstruction where you could see casts or cholesterol emboli.
RPGN secondary to nephritic syndrome is due to either crscentic GN or endocapillary proliferation.
How does Nephritic Syndrome Result in Dysmorphic Hematuria
there is active urine. there are neurophils entering the subendothelial space. inflammation of the vesesl wall caused by WBC that have been stimulated by anti-GBM bound to the capillary basement membranes. You see casts (characterisic of dysmorphic hematuria)
LECUTURE: there are antibodies in the blood that attach ot the basement membrane. the GDM gets ruptured and it goes into the urine. the smashed blood cells go through GBma nd it disrupts their shape, making the casts look dysmorphic.
How does Nephritic Syndrome Cause Hypertension?
- obsutrction of the capillary luminae (amongst other mehcnaisms) decreases tubular blood flow and GFR
- this leads to activation of the RAAS system and subsequent hypertension
- nephritic syndrome mediated hypertension is very well treated with ACE-I or ARB
LECTURE: the lumen is narrower due to neutrophilic inflammation caused by the antigobdies. the endocapillary cells also proliferate in response to antibodies, causing further narrowing.
tubular blood flow is post glomerular (goes after the efferent). if you have narrowing glomerulus tubules, there is less flow to the tubular vessels. causes activations of RAS system–> hypertenion
How does nephritic syndrome lead to decreased GFR?
because the tubules are all plugged up with neutrophils, the blood is not getting through glomerulus, the GFR then drops
- if those tubules are relaly packed, you can get acute tubular necrosis happening due to severe compromise of tubular blood flow
causes of nephritic syndrome: on IF biopsy, you see linear shapes. what could cause this type of nephritic syndrome?
lines on bipsy = endothelium is being coated by the antibodies.
-
causes of nephritic syndrome: on IF biopsy, you can see granular dots. what could cause this type of nephritic syndrome?
immune complex disease!
causes of nephritic syndrome: on IF biopsy, you see nothing. what could cause this type of nephritic syndrome?
Pauci immune issue! ANCA associate vasculitis (AAV)
investigations for nephritic syndrome
tx; steroids and cyclophosphamide
