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Nephritic Syndrome

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Topic updated on 02/24/17 8:09am

Introduction
  • RBC castsDiffuse glomerular inflammation resulting from
    • post-streptococcal glomerular neprhtis
    • IgA glomerular nephritis
    • rapidly progressive glomerulonephritis
    • multiple myeloma
 
Presentation
  • Symptoms/Physical exam
    • edema of the faces (periorbital edema) and ankles
    • hypertension
    • hematuria (smoky urine)
Evaluation
  • Labs 
    • first test in suspected renal disease should be a urinalysis 
    • azotemia (elevated BUN and Creatinine)
    • mild to moderate proteinuria (hyaline casts with any proteinuria)
    • Urine red cells and RBC Casts

 
Nephrotic Syndrome
Nephritic Syndrome
Chronic Disease
Proteinuria
+ + +
+ / -
+ / -
Hematuria
+ / _
+ + +
+ / -
Cells
+ / _
+ RBCs / + WBCs
+ / -
Casts
Fatty Casts
RBC and granular casts
Waxy/pigmented/granular casts
Lipids
Free fat droplets
Oval fat bodies
   

Post Streptococcal Glomerulonephritis (PSGN)
  • Prototype acute glomerulonephritis
  • Classically occurs weeks after an infection with group A hemolytic streptococci (S. pyogenes)
    • can follow impetigo or pharyngitis
  • Disease caused by antigen-antibody complex on the glomerular membrane
  • Presents with symptoms of nerphritic syndrome (above)
  • Labs 
    • elevated ASO
    • decreased serum C3
  • Immunofluorescence shows course granular IgG or C3 deposits
  • Usually self- limited and treatment not required
    • because immune complex driven, does not improve with Abx
Berger's (IgA nephropathy)
  • Most common worldwide nephropathy
  • Due to IgA in mesangium
    • serum IgA increased in 40%
    • immunofluorescent stains show IgA in the mesangium
  • Presents with symptoms of nerphritic syndrome (above) and
    • concurrently or within several days of URI
    • recurrent episodes of gross hematuria
  • 25% progress to renal failure
  • Prednisone for acute flares but it does not halt disease progression
Cresentic (rapidly progressive) Glomerulonephritis
  • Progresses to renal failure within weeks or months
  • May be part of PSGN or other systemic disease
  • Presents with symptoms of nerphritic syndrome (above)
  • Treat with prednisone or plamapheresis
Henoch-Schonlein Purpura (HSP)
  • See Henoch-Schonlein Purpura 
Multiple Myeloma
  • Renal involvement:
    • Increased production of light chain leads to tubular plugging by Bence-Jones proteins
    • Secondary hypercalcemia also contributes to development of "myeloma kidney"
    • Myeloma cells can directly invade kidney
    • Defect in antibody production leaves patient susceptible to chronic infections by encapsulated bacteria (e.g., E. Coli)
      • leads to chronic renal failure
  • Treat underlying myeloma

 



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Qbank (1 Questions)

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(M2.RL.167) A 12-year-old male is brought to the clinic by is mother for what she describes as a "swollen face." His recent medical history is significant for impetigo two weeks ago. On physical exam he has elevated blood pressure for his age. What is the most appropriate next step in the management? Topic Review Topic

1. Urinalysis
2. Antistreptolysin O titers
3. Renal ultrasound
4. Abdominal CT
5. Empiric antibiotics

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