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.