Flashcards in Renal 2 Deck (29):
Name 3 features of nephritic sydnrome
1. dark colored urine
2. erythrocytes in urine microscopically
3. The patient may also have renal failure (Increase in Serum creatinine and blood urea nitrogen/BUN) in which case this is called acute nephritic syndrome
name 2 diseases that cause asymptomatic isolated hematuria
1. IgA nephropathy
2. Alport syndrome
Whats the most common type of primary glomerulonephritis worldwide?
Who does IgA nephropathy typically affect?
-children and young adults
Upon staining, what would you see microscopically for IgA nephropathy?
mesangial proliferation/hypercellularity (>3 cells per mesangial region)
T/F- although most patients with IgA nephropathy have a good prognosis, proteinuria is a predictor of progressive disease
How do you treat IgA nephropathy?
No specific treatment available, in progressive cases steroids and other immunosuppressive agents may be tried with variable success rates.
What is the "vasculitic variant" of IgA nephropathy?
Henoch Schonlein purpura
-usually seen in children
name 3 symptoms associated with Henoch Schonlein purpura
2. abdominal pain
If you biopsied the vessels in someone with HSP, what would you find?
IgA in subdermal vessels
What are the characteristics of alport syndrome?
-mutation in alpha-5 chain of type IV collagen (X linked dominant)
-GBM thickening, splitting, and lamination
-"basket weave" pattern upon staining
Which two conditions (not diseases per say but descriptive pathological changes seen in the glomerulus) cause acute nephritic syndrome?
1. crescentic glomerulonephritis
2. diffuse proliferative glomerulonephritis
T/F- crescentic glomerulonephritis has a low morbidity
False, Severe renal failure and death can result if untreated.
What forms the crescents?
Crescents are proliferation of cells lining the Bowman’s space
along with incoming inflammatory cells as result of glomerular
capillary fibrinoid necrosis
Describe the expected IF stain, lab values, and causes of Type 1 crescentic glomerulonephritis
-IF: linear capillary loop IgG
-Labs: elevated serum anti-GBM antibody
-Cause: Anti-GBM disease (aka Goodpasture's disease)
Describe the expected IF stain, lab values, and causes of Type II crescentic glomerulonephritis
-IF: granular deposits in mesangium or capillary loops
-Labs: elevated Antinuclear antibodies (ANAs), anti-dsDNA etc.
-Cause: lupus nephritis, IgA nephropathy
Describe the expected IF stain, lab values, and causes of Type III crescentic glomerulonephritis
-IF: no deposits
-cause: ANCA diseases (wegeners granulomatosis, microscopic polyarteritis)
Anti-GBM disease is caused by abnormal production of antibodies against what?
collagen IV basement membrane of glomerulus and lung
How do you treat crescentic glomerulonephritis? What do you add for anti-GBM disease?
-treat all with corticosteroids, cytotoxic agents (cyclophosphamide)
-add plasmapharesis for anti-GBM
ANCA associated glomerulonephritis is also known as what?
Pauci-immune crescentic glomerulonephritis
Crescents imply what?
Name 2 causes of diffuse proliferative glomerulonephritis (DPGN)?
1. acute-post streptococcal glomerulonephritis
2. proliferative (active) lupus nephritis
How long after a group A strep infection would you see DPGN?
-about 2 weeks
Acute post-streptococcal GN would present with what findings?
-acute nephritic syndrome
-elevated ASO titer
What immune deposits would be seen on IF (immunoflourescence) in post strep glomerulonephritis?
-C3 and IgG deposits in capillary loops (subepithelial deposits "humps")
if you see SUBEPITHELIAL HUMPS what is it?
acute post infectious glomerulonephritis
What would provide serological evidence of lupus (suggesting proliferative lupus nephritis)?
-anti-nuclear antibody, anti-dsDNA
-low complements c3 and c4
A "full house pattern" IF stain suggests what?
IgG, IgA, IgM, C3, C1q all present suggesting proliferative lupus nephritis