ACUTE NEPHRITIC SYNDROME

Acute glomerular inflammation

Sudden onset of ARF (acute renal failure), oliguria

o
ARF: increase in creatinine level of 1mg/day or more

Decrease RBF (renal blood flow) and GFR

Clinical manifestations
o
ECF volume expansion
o
Edema
o
Hypertension

Urinalysis
o
RBC cast
o
Dysmorphic RBC
o
Subnephrotic proteinuria
o
Macroscopic hematuria

Pathology: Proliferative GN
o
Acute diffuse
o
Focal
o
Mesangioproliferative
I.

II.

III.

RAPIDLY PROGRESSIVE GLOMERUOLONEPHRITIS (RPGN)

Renal failure over weeks to months
Clinical manifestations
o
Nephritic urinary sediments
o
Subnephrotic proteinuria
o
Variable oliguria, hypervolemia, edema,
hypertension
Pathology: crescent formation
Diagnosis: Renal biopsy
o
IF Microscopy

Scattered granular deposits of Ig

More discrete linear deposition of Ig

along the GBM

Paucity or absence of Ig
o
3 serologic markers

C3

Titers of anti-GBM antibody

ANCA: antinuclear cell antibodies

IV.

V.

NEPHRITIC SYNDROME INDUCED BY IMMUNE-COMPLEX GN

Idiopathic
Response to a known antigenic stimulus
Form part of a multisystem immune-complex disorder

POST-STREPTOCOCCAL GN
Leading cause of acute nephritic syndrome
10 days after pharyngitis
2 weeks after skin infection
Clinical manifestations
o
Proteinuria
o
Hematuria
o
Urinary sediments
o
Normal or slightly elevated creatinine
LM
o
Diffuse proliferative GN
o
Crescents: uncommon
o
Extraglomerular: mild
IM
o
diffuse granular deposition of IgG and C3
EM
o
large electron dense immune deposits in the
subendothelial, subepithelial and mesangial areas
Acute/subacute endocarditis
o
Diffuse proliferative immune-complex GN
o
Hypocomplimentemia
Treatment
o
Antibiotic usually lasts for 2 weeks
o
Supportive therapy
o
Diuretics for edema
o
Antihypertensive agents
Prognosis: excellent

SLE-LUPUS NEPHRITIS

VI.

Renal involvement in 40-85%

Isolated abnormality of the urinary sediments
o
Nephritic Nephrotic Chronic renal Failure
(CRF)
o
On and off
Treatment: steroids
Presence of blood in urine
Proteinuria
Increase in ANA, C3 and double stranded DNA
President Marcos has this
CRYOGLOBULINEMIA GLOMERULOPATHY
Type II and type III mixed myoglobulinemia
Clinical manifestations
o
Proteinuria
o
Hematuria
o
Urinary sediments
Renal disease is a complication 12-24 months
Nephrotic range proteinuria
Microscopic hematuria
HPN
Decrease C3, C4, CH50
ANA-speckled, Hep C RNA+
Treatment: steroids with or without cyclophosphamide,
plasmapharesis
HENOCH-SCHONLEIN PURPURA
Abdominal pain, joint pains, hematuria, infection in the
urine, changes in immune system
LM: mild mesangial proliferative GN
IM: mesangial IgA
IgG and C3 present
EM: mesangial immune deposits
Treatment: supportive, steroids and /or cytotoxic agents
Prognosis
o
generally excellent, CRF and HPN <10%