Nephritic syndrome

Presentation- Oliguria, hematuria,  HTN, AKI

*PSGN, lupus, croglobulinemia, HSP C3↓, Ig A C3 normal


1.Post-streptoccal glomerulonephritis (PSGN)

Prevalence- 2~6 y/o

Etiology- 14 days after Group A streptococcus infection

Lab

1.Normal C4, C3↓ & C50↓(first 2 wks), 1~2 months recover

2.ASO, anti-DNase B, anti-NAD, and AHase elevated→ after pharyngeal infection(1~3 wks)

3.Anti-DNase B and AHase elevated→ after skin infection(3~6 wks)

Pathology- Dome-shaped subepithelial→ humps

Prognosis- Diuresis 1 wks, Cre recover 3~4 wks, hematuria recover 3~6 wks, proteinuria recover slower

DDX

1.Membranoproliferative glomerulonephritis (MPGN)→ urinary abnormalities and hypocomplementemia beyond 4 to 6 weeks

2.Ig A nephropathy→ shorter time between the antecedent illness and hematuria

Treatment

1.Supprotive care- sodium and water restriction and loop diuretics

2.Still infection- Penicillin

3.Blood pressure control- nicardipine

4.Acute renal failure- dialysis



2.Ig A nephropathy

Forward- Nephritic most common

Prevalence- 10~30 y/o male

Etiology- 2 days after URI, Liver cirrhosis, Crohn’s, GI tumor, COPD, ankylosing spondylitis

Lab- IgA↑ , C3 normal

Treatment- Corticosteroid + ACEi

Prognosis- ⅓ became CRF after 20 years



3.Alport syndrome

Gene- X-linked, XD

Etiology- Type 4 collagen defect

Presentation- Deaf, cataract,anterior lenticonus

Prognosis- Male ESRD, female only subclinical hearing loss and intermittent hematuria



4.Anaphylactoid purpura (Henoch-Schonlein purpura)(HSP)

Forward- After URI

Prevalence- 4~7 y/o

Presentation- Lower limbs palpable purpura, abdominal pain, joint pain, microscopic hematuria

Diagnosis(>=2)

1.Age<20

2.Palpable purpura

3.Bowel angina

4.Biopsy showed granulocyte on vessel wall

Pathology- Leukocytoclastic vasculitis(Ig A and C3), kidney(Ig A in mesangium)(Berger disease)

Treatment- Good prognosis without treatment


5.Lupus nephritis (SLE)


Published by Steve Johnson

I am a doctor who like to organise knowledges and share ideas with others. As a doctor, a lot of knowledges influx everyday and need some patient to organise and absorb. Here was my notes to share with you and hope to save your time to know it.

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