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Nephrotic / Nephritic syndromes

Poststreptococcal glomerulonephritis NEPHRITIC- most common type of postinfections GN; usually follows group A strep infection of the skin and pharynx LM: glomeruli enlarged and hypercellurlar, neutrophils, "lumpy bumpy"; EM subepithelial humps; IF granular pattern; ICs activate complement p
Rapid Progressive (crescentric) glomerulonephritis NEPHRITIC - rapid loss of renal function progresses to acute renal failure; LM and IF; may or may not be associated with crescent formation (# of crescents is what determines prognosis) Associated with goodpastures, microscopic polyarteritis (p-anca) and
Membranoproliferative glomerulonephritis [diffuse proliferative GN] NEPHRITIC -subendothelial IC deposits with granular IF; EM subendothelial humps "tram tracks"; DNA-anti DNA ICs activate classical complement pathway; common cause of death is SLE, "wire looping"
IgA glomerulonephropathy (Bergers disease) Most common GN almost equal incident of nephritic or neprhotic presentation; Affects children and adults, often post infectious; increased mucosal synthesis and decreased clearance of IgA; increased serum IgA; Mesangial IgA IC deposits within granular. Pr
Alport syndrom split basement membrane; collagen IV mutation; nerve deafness and ocular disorders
Nephritic syndrome hypertension [due to salt retention] periorbital puffiness due to salt retention oliguria (<400 ml urine/day) due to decrease in GFR from inflamed glomeruli hematuria-dysmorphic RBC with irregular membranes, neutrophils in sediment RBC casts are KEY
Nephrotic syndromes Key finding is proteinuria greater than 3.5 g/24hrs generalized pitting edema and acites due to hypoalbuminemia, and spontanteous peritonitis (strep pnemo); hypertension in some types; hypercoaguable states due to loss of antithrombin III, hypercholester
Membranous glomerulonephritis NEPHROTIC:MCC of nephritic syndrome in adults; Drugs captopril; infx with HBV, plasmodium malaria, syphillis; Malignancy: carcinomas non-hodkins lymphoma; Autoimmune disease; SLE LM: diffues thickening of memebranes EM: silver stain show spike and dome
Minimal change disease NEPHROTIC:negative IF, EM shows fusion of podocytes and no deposits; T cell cytokines cause the GBM to lose its negative charge; selective proteinuria (albumin and globins), often preceeded by respiratory infxn or routine immunization; structurally normal
Focal segmental glomerular sclerosis NEPHROTIC:Primary of secondary causes disease secondary cause is HIV and IV heroin use negative IF; EM focal damage of visceral epithelial cells LM: segmental sclerosis and hyalinosis seen in african americans
Diabetic nephropathy LM : kimmelston wilson "wire loop" lesions, basememnt memebrane thickening;nodular glomerular changes
Amyloidosis IF congo red stain apple green bifringence; Associated with Multiple myeloma, chronic conditions, TB rheumatic arthritis
Created by: Roshani