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Nephritic Syndromes Dr. Raid Jastania
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Nephritic Syndrome Diffuse Proliferative (post infectious) GN
Rapidly Progressive GN (Crescentic GN) IgA Nephropathy Chronic Glomerulonephritis
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Acute Proliferative/Diffuse Proliferative/Post-infectious Glomerulonephritis
Post strep (staph, measles, mumps, HepB, HepC) Immune complex
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Acute Proliferative/Diffuse Proliferative/Post-infectious Glomerulonephritis
Light microscopy
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Acute Proliferative/Diffuse Proliferative/Post-infectious Glomerulonephritis
Light microscopy: Proliferative: mesangial, endothelial, inflammation (neutrophils) Thrombi necrosis
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Acute Proliferative/Diffuse Proliferative/Post-infectious Glomerulonephritis
Electron microscopy:
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Acute Proliferative/Diffuse Proliferative/Post-infectious Glomerulonephritis
Electron microscopy: Sub-epithelial humps Other deposits
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Acute Proliferative/Diffuse Proliferative/Post-infectious Glomerulonephritis
Immuno Fluorescence: Ig, Comp
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Acute Proliferative/Diffuse Proliferative/Post-infectious Glomerulonephritis
Prognosis
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Acute Proliferative/Diffuse Proliferative/Post-infectious Glomerulonephritis
Prognosis: Progression is uncommon 15-50% may progress to CRF
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Rapidly Progressive GN (Crescentic GN)
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Rapidly Progressive GN (Crescentic GN)
Type I: Anti GBM 12% LM: Crescent IF: Linear deposits, IgG, C3 EM: deposits, GBM rupture
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Rapidly Progressive GN (Crescentic GN)
Type II: Immune complex 44% Post strep, IgA nephropathy LM: crescent IF: deposits similar to the primary disease EM: deposits, GBM rupture
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Rapidly Progressive GN (Crescentic GN)
Type III: Pauci-immune, ANCA positive 44% Vasculitis: Wegener granulomatosis, microscopic polyarteritis LM: crescent IF: neg EM: neg, GBM rupture
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IgA Nephropathy
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IgA nephropathy Children, young adults
Microscopic, gross hematuria, recurrent Loin pain Association: Henoch-Schonlein purpura, Celiac disease, Liver disease
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IgA nephropathy Pathogenesis
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IgA nephropathy Pathogenesis: Abnormal IgA production and clearance
High level of IgA Deposits of IgA Immune complex Activation of alternative complement system (C3 only)
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IgA nephropathy Light micorscopy
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IgA nephropathy Light microscopy: Normal or mesangial expansion
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IgA nephropathy Immuno Fluorescence:
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IgA nephropathy Immuno Fluorescence: IgA in mesangium
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IgA nephropathy Electron microscopy
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IgA nephropathy Electron microscopy: deposits
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IgA nephropathy Prognosis:
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IgA nephropathy Prognosis: 25-50% progress to CRF
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Chronic Glomerulonephritis
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Chronic Glomerulonphritis
Late stage of glomerular disease Found in end-stage renal disease/CRF Represent 30-50% of patients on hemodialysis Young and middle age
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What are the possible causes of this appearance of the kidneys?
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Describe the four compartments (glomeruli, tubules, interstitium, and vasculature)
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Describe the abnormality
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Chronic Glomerulonphritis
Gross: Contracted kidneys Atrophic with granular surface
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Chronic Glomerulonphritis
Micro: Glomerular sclerosis/hyalinizaiton Interstitial fibrosis/inflammation Tubular atrophy Thick vessels (hypertension)
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