Potpourri
Things needle to know!
DDX ...It may or may not be Lupus
Final Jeopardy
100
Immunologic Kidney response by a Renal infection
Post Infectious Glomerulonephritis
100
Name 4 clinical findings ( physical / vitals/ labs) in 6 yr old presenting with edema and
Physical: confirm edema
Vitals: HTN
Labs: Proteinuria, hematuria, hypoalbuminemia
100
A 12 yr old presents with a hx of rash, edema, hematuria and intermittent fevers. Exam shows 1+ pitting edema .
Pertinent labs show Cr 1.5,Albumin:3 UPC : 3 and C3: 40 C4 : 4 .
Lupus Nephritis:
Both C3 and C4 low , with AKI and nephritis
200
What is the incidence of Post infectious Related GN in resource rich countries vs resource limited countries
Overall: decreasing
Resource limited Countries: Higher
Resource rich Countries:Lower
200
Describe Light Microscopy finding in this picture?
Glomeruli show diffuse hypercellularity due to mesangial and endothelial cell increase and a large number of polymorphonuclear neutrophils (PMNs)
200
A 8yr old present to EC hx edema, SOB, hematuria lethargy , hematuria with decreased UOP that has gotten progressively worse over the last 3 weeks. Mom remembers her getting a sore throat 1 month ago but didnot get treated with antibiotics. In the EC sig vitals show BP is 140/90, SpO2: 89% Weight of 50kg (last weight 3 months ago 40kg. Your exam shows , decrease AE in lung bases , anasarca. Pertinent labs show Cr 5 ,K 5.5. Ca 8 Albumin:3,Hb 8, UPC : 3 .Diagnosis ? additional work up and next step in management?
PIGN with concern for RPGN
Labs C3 C4 Imaging Renal Biopsy
Pulse steroids
300
This type of PIGN is typically caused by Staphlococcal infections
IgA-dominant acute infection-related glomerulonephritis associated with glomerular deposition of IgA
300
What does this picture show?
Scattered capillary wall granular deposits Starry nights
300
A 6 yr old referred from PCP with a hx edema, hematuria over the last 3 weeks and is now hypertensive. Your exam shows 1+ pitting edema and confirms hypertension . Pertinent labs show Cr 1.5,Albumin:3 UPC : 3 and C3: 40 C4 :20. Diagnosis and next step in management?
PIGN and treated with lasix albumin fluid and salt restriction .
400
What is the typical history of PIGN in children acute , short term and long term?
Acute PSGN usually last for < 2 weeks
Renal function and low complement usually improve in 4-8 weeks, but may take as long as 3 months
Hematuria may continue for up to 6 months
At 10- to 20-year follow-up 20% reported to have abnormal urinalysis or renal function
400
Name 4 indications for a renal biopsy
•Unclear diagnosis
Progressive loss of renal function (to determine diagnosis and appropriate therapy)
Failure to recover as expected
Persistent hypocomplementemia (usually > 3 months)
Persistent high-grade proteinuria
400
Despite Lasix and albumin she remains hypertensive you start her on amlodipine. You continue to follow her up in clinic and after 3 months her C3 is 50.
What is your next step in management?
DDX
Renal biopsy and C3 GN
500
Name 2 different organisms ( not including staph and strep ) in each group ( bacterial , viral, fungal , parasitic) that causes Infectious related GN
Bacteria:Enterococci, Listeria monocytogenes, salmonella klebsiella mycobacterium tuberculosis
Viral infections including heb B , HepC , EBV CMV
Parasitic infections including helminthic (parasitic worms) ,protozoal
Fungal infections including Candida, cryotococcus
500
Name 2 possible biomarkers associated with PSGN?
Nephritis-associated plasmin receptor (NAPlr), also known as streptococcal glyceraldehyde-3-phosphate dehydrogenase (GAPDH)
Streptococcal pyrogenic exotoxin B (SpEB)
500
Name 5 additional testing to order after Biopsy is concerning for C3GN
Serum complement proteins eg C5b-9
Autoantibodies such as C3Nephritic factor, C5Nephritic factor, C4Nephritic factor
Genetic testing: complement gene mutations in complement factor H factor I , C3 and complement factor H related proteins
500
In his work “About Inner Sufferings, who first described acute GN ?
Hippocrates
Hippocrates uses the term “nephritis” to describe hematuria, strangury (vesical tenesmus), and oliguria. He attributed it to infection and overconsumption of starch—probably a description of present-day post-infectious glomerulonephritis. He emphasized a lot on urine examination and stated that the presence of frothy urine was suggestive of chronic disease (proteinuria)