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    Toronto Notes Nephrology 2015 22

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    IgA nephropathy is the most common type of primary glomerular disease worldwide, usually presenting after a viral upper respiratory tract infection. Nephritic syndrome features include proteinuria, hematuria, azotemia, red blood cell casts, oliguria, and hypertension. The etiology of acute nephritic syndrome can be divided into those with low or normal complement levels, and is frequently immune-mediated with immunoglobulin and C3 deposits along the glomerular basement membrane. Rapidly progressive glomerulonephritis is a subset of nephritic syndrome that progresses over weeks to months, and any cause of glomerulonephritis can present as such except for minimal change disease.

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    Toronto Notes Nephrology 2015 22

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    IgA nephropathy is the most common type of primary glomerular disease worldwide, usually presenting after a viral upper respiratory tract infection. Nephritic syndrome features include proteinuria, hematuria, azotemia, red blood cell casts, oliguria, and hypertension. The etiology of acute nephritic syndrome can be divided into those with low or normal complement levels, and is frequently immune-mediated with immunoglobulin and C3 deposits along the glomerular basement membrane. Rapidly progressive glomerulonephritis is a subset of nephritic syndrome that progresses over weeks to months, and any cause of glomerulonephritis can present as such except for minimal change disease.

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    Toronto Notes Nephrology 2015

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    IgA nephropathy is the most common type of primary glomerular disease worldwide, usually presenting after a viral upper respiratory tract infection. Nephritic syndrome features include proteinuria, hematuria, azotemia, red blood cell casts, oliguria, and hypertension. The etiology of acute nephritic syndrome can be divided into those with low or normal complement levels, and is frequently immune-mediated with immunoglobulin and C3 deposits along the glomerular basement membrane. Rapidly progressive glomerulonephritis is a subset of nephritic syndrome that progresses over weeks to months, and any cause of glomerulonephritis can present as such except for minimal change disease.

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    174 views1 page

    Toronto Notes Nephrology 2015 22

    Uploaded by

    JUSASB
    IgA nephropathy is the most common type of primary glomerular disease worldwide, usually presenting after a viral upper respiratory tract infection. Nephritic syndrome features include proteinuria, hematuria, azotemia, red blood cell casts, oliguria, and hypertension. The etiology of acute nephritic syndrome can be divided into those with low or normal complement levels, and is frequently immune-mediated with immunoglobulin and C3 deposits along the glomerular basement membrane. Rapidly progressive glomerulonephritis is a subset of nephritic syndrome that progresses over weeks to months, and any cause of glomerulonephritis can present as such except for minimal change disease.

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    of 1

    NP22 Nephrology

    Parenchymal Kidney Diseases

    Essential Med Notes 2015

    Glomerular Syndromes
    1. ASYMPTOMATIC URINARY ABNORMALITIES
    Clinical/Lab Features
    proteinuria (usually <2 g/d) and/or microscopic or macroscopic hematuria
    isolated proteinuria
    can be postural
    occasionally can signal beginning of more serious GN (e.g. FSGS, IgA nephropathy,
    amyloid, diabetic nephropathy)
    hematuria with or without proteinuria
    IgA nephropathy (Bergers disease): most common type of primary glomerular disease
    worldwide, usually presents after viral URTI
    hereditary nephritis (Alports disease): X-linked nephritis often associated with
    sensorineural hearing loss; proteinuria <2 g/d
    thin basement membrane disease: usually autosomal dominant, without proteinuria;
    benign
    benign recurrent hematuria: hematuria associated with febrile illness, exercise, or
    immunization; a diagnosis of exclusion after other possibilities are ruled out

    Features of Nephritic Syndrome


    PHAROH
    Proteinuria
    Hematuria
    Azotemia
    RBC casts
    Oliguria
    Hypertension

    IgA nephropathy is the most common


    type of primary glomular disease
    worldwide

    2. NEPHRITIC SYNDROME
    ACUTE NEPHRITIC SYNDROME
    a subset of nephritic syndrome in which the clinical course proceeds over days
    Etiology
    etiology can be divided into low and normal complement levels (see Figure 14)
    frequently immune-mediated, with Ig and C3 deposits found in GBM
    outcome dependent on etiology
    Clinical/Lab Features
    proteinuria (but <3.5 g/1.73 m2/d), abrupt onset hematuria (microscopic or macroscopic,
    azotemia (increased Cr and urea), RBC casts and/or dysmorphic RBCs in urine, oliguria, HTN
    (due to salt and water retention), peripheral edema/puffy eyes, smoky urine
    Glomerulonephritis with Nephritic Features

    Anti-GBM Mediated
    (RPGN Type I) (15%)

    Immune Complex Mediated


    (RPGN Type II) (24%)

    Non-Immune Mediated
    (RPGN Type III) (60%)

    Double Antibody Positive Disease


    (RPGN Type IV)

    Linear IF pattern due to IgG and C3


    deposition along capillary loops

    Granular pattern due to subendothelial


    or subepithelial deposits of IgG and C3

    Pauci-immune: no immune staining

    Has features of Type I and Type III


    Double antibody positive

    anti-GBM +ve

    With lung
    hemorrhage

    Without lung
    hemorrhage

    Goodpastures
    disease

    Anti-GBM
    disease

    C3 normal

    Decreased C3

    IgA nephropathy
    Henoch-Schnlein
    purpura

    Membranoproliferative
    GN
    SLE
    Infective endocarditis
    Post-infectious GN
    Cryoglobulinemia

    ANCA +ve

    c-ANCA +ve

    p-ANCA +ve

    Granulomatosis
    with
    polyangiitis

    Churg-Strauss
    Microscopic
    polyangiitis

    Figure 14. Approach to nephritic syndrome

    RAPIDLY PROGRESSIVE GLOMERULONEPHRITIS/CRESCENTIC


    GLOMERULONEPHRITIS
    a subset of nephritic syndrome in which the clinical course proceeds over weeks to months
    clinical diagnosis, not histopathological
    any cause of GN can present as RPGN (except minimal change disease)
    additional etiologies seen only as RPGN: Goodpastures syndrome and granulomatosis with
    polyangiitis (previously called Wegener's granulomatosis)

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