Podcast
Questions and Answers
What is the underlying pathological process that primarily contributes to the development of nephritic syndrome?
What is the underlying pathological process that primarily contributes to the development of nephritic syndrome?
- Glomerular sclerosis leading to reduced filtration.
- Tubular necrosis causing impaired reabsorption.
- Increased glomerular basement membrane thickness.
- Glomerular inflammation altering the filtration barrier. (correct)
What are the clinical characteristics that define nephritic syndrome?
What are the clinical characteristics that define nephritic syndrome?
- Massive proteinuria, hypotension, hyperkalemia, and metabolic acidosis.
- High-level proteinuria, edema, hyperlipidemia, thromboembolism.
- Nephrotic range proteinuria, ascites, and normal blood pressure.
- Low-level proteinuria, microscopic hematuria, oliguria, hypertension. (correct)
In the context of nephritic syndrome, what is the clinical significance of observing 'cola-colored urine'?
In the context of nephritic syndrome, what is the clinical significance of observing 'cola-colored urine'?
- Indicates severe dehydration and concentrated urine output.
- Implies proteinuria, indicating elevated protein levels in the urine.
- Suggests hematuria, where red blood cells are present in the urine. (correct)
- Signifies the presence of bilirubin due to liver dysfunction.
Why might a patient with nephritic syndrome exhibit hypertension?
Why might a patient with nephritic syndrome exhibit hypertension?
Which immunological mechanism is most likely to underlie the glomerular injury observed in post-streptococcal glomerulonephritis (PSGN)?
Which immunological mechanism is most likely to underlie the glomerular injury observed in post-streptococcal glomerulonephritis (PSGN)?
In a patient diagnosed with IgA nephropathy, what key finding on immunofluorescence microscopy of a renal biopsy would support this diagnosis?
In a patient diagnosed with IgA nephropathy, what key finding on immunofluorescence microscopy of a renal biopsy would support this diagnosis?
Which of the following pathophysiological processes is most characteristic of rapidly progressive glomerulonephritis (RPGN)?
Which of the following pathophysiological processes is most characteristic of rapidly progressive glomerulonephritis (RPGN)?
What underlying condition is indicated by the presence of Anti-GBM antibodies and linear immunofluorescence patterns in a patient with nephritic syndrome?
What underlying condition is indicated by the presence of Anti-GBM antibodies and linear immunofluorescence patterns in a patient with nephritic syndrome?
In Henoch-Schönlein purpura (HSP), what specific immune complex is typically involved, leading to vasculitis and subsequent renal manifestations?
In Henoch-Schönlein purpura (HSP), what specific immune complex is typically involved, leading to vasculitis and subsequent renal manifestations?
What is a key element to consider when developing a differential diagnosis for a patient presenting with hematuria?
What is a key element to consider when developing a differential diagnosis for a patient presenting with hematuria?
When evaluating a patient with suspected nephritic syndrome, what is the primary role of a renal biopsy?
When evaluating a patient with suspected nephritic syndrome, what is the primary role of a renal biopsy?
What is the rationale behind restricting water and salt intake in managing nephritic syndrome?
What is the rationale behind restricting water and salt intake in managing nephritic syndrome?
What should be a key consideration when choosing immunosuppressive medications for a patient with nephritic syndrome?
What should be a key consideration when choosing immunosuppressive medications for a patient with nephritic syndrome?
In the context of immunofluorescence findings, what type of pattern is typically associated with Anti-GBM disease?
In the context of immunofluorescence findings, what type of pattern is typically associated with Anti-GBM disease?
What role does proteinuria play in the pathophysiology of nephritic syndrome, distinguishing it from nephrotic syndrome?
What role does proteinuria play in the pathophysiology of nephritic syndrome, distinguishing it from nephrotic syndrome?
How does the presence of red blood cell casts in the urine typically relate to the location and nature of kidney damage in nephritic syndrome?
How does the presence of red blood cell casts in the urine typically relate to the location and nature of kidney damage in nephritic syndrome?
Which laboratory finding is most indicative of active glomerular injury in a patient with nephritic syndrome?
Which laboratory finding is most indicative of active glomerular injury in a patient with nephritic syndrome?
In post-streptococcal glomerulonephritis (PSGN), what specific serological marker is commonly elevated and considered indicative of a recent streptococcal infection?
In post-streptococcal glomerulonephritis (PSGN), what specific serological marker is commonly elevated and considered indicative of a recent streptococcal infection?
When a patient with nephritic syndrome presents with hemoptysis and pulmonary hemorrhage, which underlying condition should be highly suspected?
When a patient with nephritic syndrome presents with hemoptysis and pulmonary hemorrhage, which underlying condition should be highly suspected?
Concerning Membranoproliferative Glomerulonephritis (MPGN), what pathological feature seen on renal biopsy is most characteristic?
Concerning Membranoproliferative Glomerulonephritis (MPGN), what pathological feature seen on renal biopsy is most characteristic?
Which of the following conditions causing nephritic syndrome is most likely to present with a purpuric rash, joint pain, abdominal pain, and renal involvement?
Which of the following conditions causing nephritic syndrome is most likely to present with a purpuric rash, joint pain, abdominal pain, and renal involvement?
What is the significance of measuring serum complement levels (C3 and C4) in the evaluation of nephritic syndrome?
What is the significance of measuring serum complement levels (C3 and C4) in the evaluation of nephritic syndrome?
What is a crucial first step to determine in the clinical evaluation of a patient with nephritic syndrome?
What is a crucial first step to determine in the clinical evaluation of a patient with nephritic syndrome?
What should you evaluate during the physical examination of a patient with nephritic syndrome to assess for potential complications?
What should you evaluate during the physical examination of a patient with nephritic syndrome to assess for potential complications?
What is the purpose of obtaining a chest X-ray in a patient with nephritic syndrome?
What is the purpose of obtaining a chest X-ray in a patient with nephritic syndrome?
How does the prognosis typically vary among different types of glomerulonephritis causing nephritic syndrome?
How does the prognosis typically vary among different types of glomerulonephritis causing nephritic syndrome?
In a patient with nephritic syndrome, what blood pressure target is generally recommended to help slow the progression of renal disease?
In a patient with nephritic syndrome, what blood pressure target is generally recommended to help slow the progression of renal disease?
What key laboratory parameters are regularly monitored to assess the effectiveness of supportive management and immunosuppressive therapy in nephritic syndrome?
What key laboratory parameters are regularly monitored to assess the effectiveness of supportive management and immunosuppressive therapy in nephritic syndrome?
In managing a patient with nephritic syndrome and confirmed fluid overload, what class of medications is most appropriate for initial intervention to reduce edema and hypertension?
In managing a patient with nephritic syndrome and confirmed fluid overload, what class of medications is most appropriate for initial intervention to reduce edema and hypertension?
What is the most important aspect in determining medical management after an accurate diagnosis of nephritic syndrome has been made?
What is the most important aspect in determining medical management after an accurate diagnosis of nephritic syndrome has been made?
What is the first treatment you should prescribe for a 45-year-old with serum creatinine of 194 $\mu$mol/L, Blood Urea Nitrogen (BUN) of 15.0 mmol/L, Serum Potaassium of 4.0 mmol/L, and urinalysis showing blood +3 protein +1 with RBC casts. The patient has a vascultic rash with small, palpable purpuric lesions?
What is the first treatment you should prescribe for a 45-year-old with serum creatinine of 194 $\mu$mol/L, Blood Urea Nitrogen (BUN) of 15.0 mmol/L, Serum Potaassium of 4.0 mmol/L, and urinalysis showing blood +3 protein +1 with RBC casts. The patient has a vascultic rash with small, palpable purpuric lesions?
What is the significance of gross haematuria?
What is the significance of gross haematuria?
What antibodies will be seen on immunofluorescence in IgA Nephropathy?
What antibodies will be seen on immunofluorescence in IgA Nephropathy?
How long does it take for post-streptococcal glomerulonephritis to occur?
How long does it take for post-streptococcal glomerulonephritis to occur?
When should a renal doctor be seen?
When should a renal doctor be seen?
Which medication is commonly used as an immunosuppressant?
Which medication is commonly used as an immunosuppressant?
Which of the following will pulmonary symptoms present?
Which of the following will pulmonary symptoms present?
What is MPGN?
What is MPGN?
Which of the following is not part of the clinical evaluation?
Which of the following is not part of the clinical evaluation?
Which of the following may lead to rapidly progressive glomerulonephritis (RPGN)
Which of the following may lead to rapidly progressive glomerulonephritis (RPGN)
Coca-cola urine is a sign of?
Coca-cola urine is a sign of?
Linear immunofluorescence is caused by?
Linear immunofluorescence is caused by?
Flashcards
Nephritic Syndrome
Nephritic Syndrome
A collection of conditions characterized by glomerular inflammation, presenting with low-level proteinuria, microscopic hematuria, oliguria, and hypertension.
IgA Nephropathy
IgA Nephropathy
IgA deposition in the mesangium, leading to a local inflammatory response. It often presents as gross hematuria after an upper respiratory or gastrointestinal infection.
Henoch-Schonlein Purpura (HSP)
Henoch-Schonlein Purpura (HSP)
A systemic form of IgA vasculitis resulting in a purpuric rash, polyarthritis, scrotal pain, GI bleeds and nephritis.
Post-streptococcal GN
Post-streptococcal GN
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Membranoproliferative Glomerulonephritis
Membranoproliferative Glomerulonephritis
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Anti-Glomerular Basement Membrane Disease (Anti-GBM)
Anti-Glomerular Basement Membrane Disease (Anti-GBM)
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Rapidly Progressive GN (RPGN)
Rapidly Progressive GN (RPGN)
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Pathogenesis of Nephritic Syndrome
Pathogenesis of Nephritic Syndrome
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Coca-Cola colored urine in Nephritic syndrome
Coca-Cola colored urine in Nephritic syndrome
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Differential Diagnosis (DDx) of Haematuria
Differential Diagnosis (DDx) of Haematuria
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Clinical Evaluation of Nephritic Syndrome
Clinical Evaluation of Nephritic Syndrome
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Urine Dipstick
Urine Dipstick
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Albumin/Creatinine ratio
Albumin/Creatinine ratio
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Study Notes
Nephritic Syndrome Overview
- Glomerular inflammation characterizes nephritic syndrome, a collection of conditions.
- Low-level proteinuria, microscopic haematuria, oliguria, and hypertension are presentations.
Causes of Nephritic Syndrome
- IgA nephropathy
- Henoch-Schonlein Purpura (HSP)
- Post-streptococcal glomerulonephritis (GN)
- Membranoproliferative glomerulonephritis
- Anti-glomerular basement membrane (Anti-GBM) disease
- Rapidly progressive GN
Pathogenesis
- Glomerular basement membrane destruction results from injury to the glomerulus, disrupting filtration.
- Immune-mediated glomerular injury is most common, but it may be infectious, non-inflammatory, or due to systemic or hereditary conditions.
- Immunofluorescence findings classify immune-mediated nephritic syndromes.
IgA Nephropathy specifics
- It is the most common primary GN in high-income countries.
- It classically occurs as gross haematuria after an URTI, GI infection, or strenuous exercise.
- IgA deposition characterizes IgA nephropathy in the mesangium, leading to a local inflammatory response.
- Immunofluorescence observation: IgA, C3, and mesangial proliferation.
- Systemic IGA vasculitis is the cause of Henoch-Schonlein purpura.
- Purpuric rash in the extensors, polyarthritis, scrotal pain, GI bleeds, and nephritis are the results of Henoch-Schonlein purpura.
Post-Streptococcal GN
- Post-streptococcal GN occurs 2-4 weeks after Group A beta-haemolytic streptococcal infections such as pharyngitis/tonsillitis.
- Rapidly progressive glomerulonephritis (RPGN) may result.
- Diagnosis requires a positive anti-streptolysin O titre (ASOT).
- Diagnosis includes Streptococcal antigen deposits in the glomerulus with consequent immune complex formation and inflammation.
Membranoproliferative Glomerulonephritis Details
- MPGN is a histologic lesion and not a specific disease entity
- Deposition of immune complexes and dysregulation of the complement system leads to inflammation and thickening of the glomerular basement membrane.
- Biopsy will show large glomeruli and mesangial proliferation.
- "Tramline" double-basement membrane is visible on microscopy.
Anti-Glomerular Basement Membrane Disease specifics
- Uncommon
- Clinical findings: Nephritic syndrome, decreased urine output within days to weeks (possibly anuria), fatigue, and Pulmonary symptoms
- Small vessel vasculitis may be present with pulmonary haemorrhage.
- Antibodies presents to Type IV Collagen in the glomerular basement membrane( AntiGBM Ab)
- Rapidly progresses to ESKD.
Rapidly Progressive GN specifics
- Aggressive glomerulonephritis rapidly worsens to renal failure.
- Proliferation of parietal epithelial cells and macrophages characterizes Bowman's capsule.
- Causes: Small vessel/ANCA Vasculitis, Lupus Nephritis, Anti-GBM Disease, or other glomerulonephritis may transform to RPGN (IGA, Membranoproliferative).
Symptoms of Nephritic Syndrome
- Presentation is dependent on underlying aetiology.
- Symptoms: Fatigue/Malaise; coca-cola coloured urine (haematuria); decreased urine output (glomerular destruction)
- Other Symptoms: Low-grade pyrexia (infectious/autoimmune); features of vasculitis (purpuric rash, haemoptysis)
- Symptoms include signs of underlying condition (Lupus/DM).
- Symptoms of Nephrotic Syndrome can be present in advanced disease.
- Other Symptoms of advanced disease: Frothy urine (proteinuria); facial oedema/lower limb swelling; weight gain (oedema); orthopnoea/PND (pulmonary oedema)
Signs of Nephritic Syndrome
Differential Diagnosis
- DDx Haematuria: Urinary tract infection, renal stones, or renal tract malignancy.
- DDx Oedema: Nephrotic syndrome, congestive cardiac failure or liver failure
Clinical Evaluation
- Medical history evaluation: duration and progression of symptoms, recent infections, new medications, and family history.
- Complete physical examination: vitals, renal exam, cardiac exam, and respiratory exam
Laboratory Investigations
- Urinalysis: Urine dipstick for haematuria and proteinuria
- Microscopy & Culture: Acanthocytes and red cell casts indicate active glomerular injury; assess for infectious causes.
- Albumin/Creatinine ratio & Protein/Creatinine ratio: Degree of glomerular damage.
- Blood tests: FBC (anaemia, infection, eosinophilia), U&E/Bone profile (GFR, electrolyte disturbance), and CRP (active inflammation).
- Serological/Immunological tests includes: ANA, ANCA, Anti-GBM, Anti-dsDNA, Complement (C3, C4).
- Tests for: HIV/HBV/HCV, ASOT, and Immunoglobulins.
Imaging
- Chest X-Ray looks for pulmonary haemorrhage and oedema.
- Renal ultrasound assesses size and looks for masses, stones and structural abnormality,
- Renal ultrasound is used for anatomy for biopsy.
- CT/MRI/Nuclear imaging is used in specific cases.
Renal Biopsy
- It is required it for a diagnosis.
- Histopathological information about the glomeruli, tubules, interstitium, and vessels is provided.
- Renal biopsy differentiates between various types of glomerulonephritis.
- Prognostic information is provided, influencing treatment decisions.
Principles of Management
- Supportive management is used alongside blood pressure control.
- Target blood pressure is under 130/80 using Diuretics/ACEI/ARB
- Correct volume status: restrict water and salt intake, may use diuretics, monitor with daily weight.
- Regular follow-up with a nephrologist is needed to monitored blood pressure, urea & creatinine, and Urine ACR/PCR
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