mindmaps - nephritic $ *not QUITE complete*

I decided to save some time by learning only 2 of the main ones - post-infective, IgA nephropathy.

Nephritic Syndrome

• IgA nephropathy (berger Disease)
  • general features
    • affects young adults and children most commonly
      one of most common causes of recurrent microscopic / gross hematuria
      most common glomerular disease revealed by renal biopsies worldwide
      some consider it to be a localized
      variant of Henoch-Schonlein purpura
      • skin - purpuric rash
      • GI tract - abd. pain
      • Joints - Arthritis
      • kidneys
  • pathogenesis
    • IgA production and clearance may be the culprit
    • IgA level increased in 50% of patients with IgA nephropathy
    • IgA synthesis in responce to an external stimulus
    • lead to depots in mesangium
    • actiavation of alternative  complement pathway
    • initiate glomerular injury
  • morphology
    • diffuse mesangial proliferation
    • mesangial deposits of IgA
  • clinical course
    • episode of gross hematuria
      • last several days
      • subside, only to recur every few months
      • often assoc. with loin pain
    • 30-40% have only microscopic hematurea
    • 5-10% develop a typical acute nephritic $.
    • within 1-2 days of a nonspecific URTI
    • slow progress to CRF in 25-50% of cases in 20years time.
• Hereditary nephritis
  • Alport syndrome
    • associated with
      • deafness
      • various eye disorders
        • lens dislocation
        • posterior cataracts
        • corneal dystrophy
• TTP-HUS
• membranoproliferative
• Henoch-Schonlein purpura
• Poststreptococcal (Acute postinfectious) GN
  • general characteristics
    • typically caused by glomerular depots of immune complexes
      resulting in diffuse proliferation and swelling of resident glomerular cells
      frequent infiltration of leukocytes - esp. neutrophils
      inciting antigen
      • exogenous
        • poststreptococcal GN
        • pneumococcal
        • staphylococcal
        • mumps
        • measles
        • VZV
        • Hep B & C
      • endogenous
        • SLE
  • pathogenesis
    • typical features of
      immune complex depot
      • hypocomplementemia
      • granular depots of IgG and complent on GBM
  • morphology
    • 
      uniformly increased cellularity of glomerular tufts
      affects nearly all glomeruli 
      subepithelial humps
      capillary lumen filled with leukocyte
      cytoplasmic granules 
      granular depots of IgG and complement
      this depots are cleared by 2 months approx
  • clinical course
    • classic case
      • 1-4 weeks after group A strep infection
        • pharynx
        • skin
      • onset of kidney disease abrupt with...
        • malaise
        • slight fever
        • nausea
        • nephritic $
      • mild to moderate
        • hypertension
        • azotemia
      • gross hematuria
        • 
          smoky brown - rather than bright red
      • some proteinurea
      • serum complement low
      • anti-streptolysin O antibody elevated
      • prognosis
        • most children recover uneventfully
          some develop rapidly progressive GN
          due to severe injury with crescents or
          chronic renal disaease due to secondary scarring
          in adults
          • 15-50% develop ESRD over
            ensuing few years / 1-2 decades.
• general properties
  • clinical complex
    • acute onset
      hematuria
      • dysmorphic RBC
      • RBC casts in urine
      oliguria
      azotemia
      hypertension
      protinurea and edema
      not as severe as nephrotic $
    common morphology
    / pathophysiology
    • proliferation of cells within glomeruli
    • leukocytic infiltrate
    • injury of capillary walls
    • escape of RBCs
    • reduced GFR
    • ischemic kidney releasing rennin