Nephritic Syndrome

Hematuria (smoky urine ), HTN, Oliguria (inflamed ), Azotemia (BUN/Creatinine ratio ^ ), Proteinuria (periorbital swelling )
Post-strep GN

GoodPasture's Syndrome

"GPS RIM" "L.A. G.R.I.M.A"

RPGN "Crescentric"

1. Hypercellularity

1. Hypercellularity.

1. Hypercellularity.

1. Hypercellularity

2. PMN's

2. +/- Crescents

2. Crescents

2.mesangial cell proliferation

IF

IgG/C3: "Lumpy Bumpy"

IgG/C3

IgG/C3

IgA/C3 in mesangium

Smooth & Linear

"Crescents"

Mesangial deposits

EM

Granular
Sub- Epithelial

Rupture of the BM

^ mesangial cellularity

rapid progression to renal

Gross Hematuria
Most common in World (France/Japan)

LM

Other MCC: Group A Strep/impetigoM>F 20-40

M 1,4, 12 "Strep Pyogenes" Hemopotysis-->Death
Complete recovery in 95%

Collagen type IV: alpha 3 subunit

failure in weeks to months

crescent=Fibrin+macrophage

2-4wk ag titers=hematuria
SLE Type IV- looks similar

type II Hypersensitivity

& parietal epithelial cells in

Most develop RPGN

but deposits= everywhere!

^ASO titer= throat

lungs & Kidney= alpha 3, coll IV

bowman's space
Type 1: anti-glomerular BM ab

DNAse B= skin infection

25% C. O pass through Kidneys=B

100% C. O pass through Lungs=A

IgA Nephropathy (Berger's Dz)

ex. Young M hematuria, post URTI

(IgA for mucosa protection)
assoc. w/Celiac Sprue (IgA- Glidin)
dermatitis herpetiformis= itchy

IF: linear IgG &C3

Type 2: immune complex dx:

extensor dermititis

1%= rapidly progressing GN B=rapidly progressing crescents

"wire loop region "-subendo tx: Steroids + cyclophosphamide
1-2 wks, plasmaphoresis immed.
diffuse proliferative

Lupus, HSP, IgA

Type 3: Pauci immune

Kid w/ URTI (IgA) and rash on buttock.

kid: 5-15yrs old

IF: no deposits, circulating

throat=RF, skin=GN

c-ANCA or p-ANCA

erysipelas=superficial rash

Tx: plasmapheresis, steroids

Wegener's/Polyangitis

tx. Gluten free diet. HSP= vasculitis,

tal swelling )
Membranoproliferative GN
1. Hypercellularity.
2. Prolif= mesangial cells.
3. Membrano="tram track"
splitting of BM on silver stain
C3

type I: lobular, thick cap walls

mesangial cell interposition

Type I:Sub-endothelial deposit

Type II: anti-C3 convertase
<C3, early C1-4 normal
deposits in lamina densa of BM
assoc w: HIV, Hep B/C, SLE,
Leukemias/lymphomas
Type III: subendo+subepi
tram-track/splitting GBM (all)
poor prog type I & III