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Nephritic Syndromes

Nephritic Syndromes. Dr. Raid Jastania. Nephritic Syndrome. Diffuse Proliferative (post infectious) GN Rapidly Progressive GN (Crescentic GN) IgA Nephropathy Chronic Glomerulonephritis. Acute Proliferative/Diffuse Proliferative/Post-infectious Glomerulonephritis.

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Nephritic Syndromes

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  1. Nephritic Syndromes Dr. Raid Jastania

  2. Nephritic Syndrome • Diffuse Proliferative (post infectious) GN • Rapidly Progressive GN (Crescentic GN) • IgA Nephropathy • Chronic Glomerulonephritis

  3. Acute Proliferative/Diffuse Proliferative/Post-infectious Glomerulonephritis • Post strep (staph, measles, mumps, HepB, HepC) • Immune complex

  4. Acute Proliferative/Diffuse Proliferative/Post-infectious Glomerulonephritis • Light microscopy

  5. Acute Proliferative/Diffuse Proliferative/Post-infectious Glomerulonephritis • Light microscopy: • Proliferative: mesangial, endothelial, inflammation (neutrophils) • Thrombi • necrosis

  6. Acute Proliferative/Diffuse Proliferative/Post-infectious Glomerulonephritis • Electron microscopy:

  7. Acute Proliferative/Diffuse Proliferative/Post-infectious Glomerulonephritis • Electron microscopy: • Sub-epithelial humps • Other deposits

  8. Acute Proliferative/Diffuse Proliferative/Post-infectious Glomerulonephritis • Immuno Fluorescence: • Ig, Comp

  9. Acute Proliferative/Diffuse Proliferative/Post-infectious Glomerulonephritis • Prognosis

  10. Acute Proliferative/Diffuse Proliferative/Post-infectious Glomerulonephritis • Prognosis: • Progression is uncommon • 15-50% may progress to CRF

  11. Rapidly Progressive GN (Crescentic GN)

  12. Rapidly Progressive GN (Crescentic GN) • Type I: Anti GBM • 12% • LM: Crescent • IF: Linear deposits, IgG, C3 • EM: deposits, GBM rupture

  13. 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

  14. 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

  15. IgA Nephropathy

  16. IgA nephropathy • Children, young adults • Microscopic, gross hematuria, recurrent • Loin pain • Association: Henoch-Schonlein purpura, Celiac disease, Liver disease

  17. IgA nephropathy • Pathogenesis

  18. IgA nephropathy • Pathogenesis: • Abnormal IgA production and clearance • High level of IgA • Deposits of IgA • Immune complex • Activation of alternative complement system (C3 only)

  19. IgA nephropathy • Light micorscopy

  20. IgA nephropathy • Light microscopy: • Normal or mesangial expansion

  21. IgA nephropathy • Immuno Fluorescence:

  22. IgA nephropathy • Immuno Fluorescence: • IgA in mesangium

  23. IgA nephropathy • Electron microscopy

  24. IgA nephropathy • Electron microscopy: • deposits

  25. IgA nephropathy • Prognosis:

  26. IgA nephropathy • Prognosis: • 25-50% progress to CRF

  27. Chronic Glomerulonephritis

  28. 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

  29. What are the possible causes of this appearance of the kidneys?

  30. Describe the four compartments (glomeruli, tubules, interstitium, and vasculature)

  31. Describe the abnormality

  32. Chronic Glomerulonphritis • Gross: • Contracted kidneys • Atrophic with granular surface

  33. Chronic Glomerulonphritis • Micro: • Glomerular sclerosis/hyalinizaiton • Interstitial fibrosis/inflammation • Tubular atrophy • Thick vessels (hypertension)

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