Snapshot A 26-year-old man presents with hematuria, periorbital edema, and jaundice. He has a medical history of opioid use disorder with prior hospitalizations for heroin overdose. He is on methadone but is non-adherent. His blood pressure is 155/102 mmHg. Physical examination is significant for scleral icterus, hepatomegaly, and palpable purpura. Serology shows decreased C3 and C4 levels and elevated anti-hepatitis C antibodies. Urinalysis demostrates dysmorphic red blood cells and red blood cell casts. (Membranoproliferative glomerulonephritis) Introduction Clinical definition renal disease secondary to an inflammatory process injuring the glomerulus this results in damage involving the basement membrane capillary endothelium mesangium Presentation symptoms hypertension hematuria oliguria headache physical exam edema can be peripheral and/or periorbital Diagnosis studies complete blood cell count anemia may be noted azotemia complement levels C3, C4, and CH50 should be obtained urinalysis dysmorphic red blood cells (RBCs) suggests hematuria is of glomerular origin RBC casts subnephrotic range proteinuria (< 3.5 g/day) if the nephritic syndrome is severe enough it can lead to nephrotic range proteinuria (> 3.5 g/day) renal biopsy may be necessary to arrive to a definitive diagnosis and to determine prognosis Nephritic Syndrome Type Pathophysiology Renal Biopsy Diagnostic Studies and Treatment Acute poststreptococcal glomerulonephritis Glomerulonephritis secondary to nephritogenic strains of streptococcus - type III hypersensitivity reaction Light microscopy - glomerular hypercellularity e.g., polymorphonuclear leukocytes Immunofluoresence - diffuse granular pattern on glomerular capillary and mesangium deposition of IgG, IgM, and C3 Electron microscopy - electron-dense, glomerular subepithelial immune-complex deposits ("humps") Streptococcus titers and serologies are positive e.g., ASO levels ↓ serum C3 levels Typically self-resolves Rapidly progressive glomerulonephritis Goodpasture syndrome - type II hypersensitivity - anti-GBM antibodies against α3-chain of collagen type IV - antibodies to the alveolar basement membrane result in hemoptysis and lung disease Pauci-immune processes - granulomatosis with polyangiitis - microscopic polyangiitis Light microscopy and immunofluoresence - crescent-shaped deposition of fibrin, C3b, glomerular parietal cells, monocytes, and macrophages Granulomatosis with polyangiitis - PR3-ANCA/c-ANCA Microscopic polyangiitis - MPO-ANCA/p-ANCA Corticosteroids and cyclophosphamide IgA nephropathy (Berger disease) IgA immune-complex deposition in glomerular mesangial cells that results in its proliferation - patients present with hematuria and upper respiratory tract or gastrointenstinal infection Light microscopy - mesangial proliferation Immunofluoresence - IgA immune-complex deposition in the mesangium ACE inhibitor or ARB for proteinuria and hypertension Alport syndrome Collagen type IV mutation that results in an abnormal basement membrane - more commonly an X-linked genetic disorder characterized by: renal involvement ocular involvement sensorineural hearing loss Electron microscopy - glomerular basement membrane lamellation No curative treatment Membranoproliferative glomerulonephritis (MPGN) Immune-complex and/or complement protein deposition in the mesangium and subendothelium of the capillaries - this results in proliferation of the mesangium and remodeling of the capillary wall - may be secondary to hepatitis C virus hepatitis B virus C3 nephritic factor MPGN type II Can also present as a nephrotic syndrome Light microscopy - mesangial proliferation and thickening of the capillary wall Immunofluoresence - "tram-track" appearance ↓ serum C3 and C4 levels - Treat underlying disease in secondary causes e.g., control of hepatitis C virus infection
QUESTIONS 1 of 4 1 2 3 4 Previous Next Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK (M2.RL.14.54) A 38-year-old female presents to emergency department with "swollen eyes and feet." The patient states that she was in her normal state of health until one week ago when she noticed that her shoes and rings were not fitting. In the ED the patient is afebrile with vitals HR 75, BP168/83. The patient cannot comment on her baseline blood pressure. Physical exam is otherwise notable for 2+ pitting edema at the ankles and periorbital edema. In the ED, urinalysis is positive for protein. The patient is admitted, and her kidney disease is further work-up, ultimately revealing low serum C3 and "tram-tracking" on kidney biopsy (Figure A). Which of the following, if part of the patient's medical history, would be a potential etiology for the her kidney disease? QID: 104845 FIGURES: A Type & Select Correct Answer 1 8 years of HAART for HIV 9% (9/101) 2 Chronic hepatitis C without interferon therapy 52% (53/101) 3 Diagnosis of rheumaoid arthritis (RA) at the age of 28, managed with herbal medicine 22% (22/101) 4 Untreated syphilis 2% (2/101) 5 Diagnosis of type 1 diabetes at the age of 16 with intermittant periods of poor control 14% (14/101) M 6 Question Complexity E Question Importance Select Answer to see Preferred Response SUBMIT RESPONSE 2 Review Tested Concept Review Full Topic
All Videos (1) Login to View Community Videos Login to View Community Videos Alport Syndrome Renal - Nephritic Syndrome D 12/7/2018 148 views 5.0 (2) Renal | Nephritic Syndrome Renal - Nephritic Syndrome Listen Now 14:35 min 1/11/2022 43 plays 0.0 (0)