Nephritic Syndrome (Hematuria, edema, oliguria, pyuria with Hypertension, elevated creatinine, Proteinuria) RBC casts

Hemoptysis

Patients can also have mild proteinuria < 3+ on dipstick

Caused by Goodpasture Syndrome-> Autoantibodies against Noncollagenous domain of α-3 subunit in type IV collagen

It's similar to Autoimmune Hemolytic Anemia (Hypersensitivity rxn Type 2)

LM: Fibrin Crescents in Bowman Space

IM: Smooth, Diffuse , linear pattern, from linear deposition of IgG among Glomerular BM

High fever, chills, costovertebral angle tenderness, with

Pyuria, Bacteriuria are consistent with

Urine with WBC casts, Gram (-) rods

Biopsy-> Polymorphonuclear Leukocytes (PMNs) in Tubules

Common in Children 1-4 weeks after infection (impetigo)

Periorbital edema, Facial Swelling, Face Rash

Group A Streptococci (GAS)

Gross Hematuria->"Cola-Colored" urine

Elevated anti-DNase B titers-> recent infection with GAS

IM: Diffuse Granular Deposition (Immune Complex Disease)

Granular Sub-epithelial immune complex deposition

Type III Hypersensitivity

Indications of a Nephrotic Syndrome

Hyperlipidemia

Hypoalbuminemia

Massive Proteinuria

Anasarca

Patient with Organomegaly

PMH of Carpal Tunnel Syndrome and Chron Disease

LM: Mesangial deposits with Apple-green Berifringence in Congo Red Stain

Large Proteinuria, Hypoalbuminemia, Edema, Hyperlipidemia -> Indicates Nephrotic Syndrome

Is the most common cause of Nephrotic Syndrome in Children

May be triggered by Recent Infection, Immunization, or Neoplasm

Urine Fatty Casts

EM: Effacement of Podocytes

LM: Normal

Heavy proteinuria, Generalized Edema, Weight Gain-> Nephrotic Syndrome

Most common cause of Nephrotic Syndrome

LM: Thickened Glomerular Basement Membrane

Anti-phospholipase A2 receptor Antibodies

EM: Subepithelial immune deposits "Spike and Dome"

Can be caused by Infection or SLE

Associated with Solid Malignancies

Pitting edema, Frothy urine (proteinuria)-> Nephrotic Syndrome

Structural damage to GFB-> Loss of protein Hepatitis C, B infections and SLE are associated with Membranous Nephropathy

Patient will have Hypoalbuminemia -> +activating RASS -> Increasing Hepatic Lipoprotein Synthesis (Increased Lipoproteins)

Increased Glomerular Permeability -> Lipiduria and Fatty Casts

Proteinuria-> Decrease Antithrombin III, Antibodies, and Transport proteins (Vit. D, Thyroxine)

Flank pain and hematuria with filling defect indicate Acute Renal Vein Thrombosis-> Hypercoagulable state

Increased urinary Frequency, Difficulty initiating urination. Symmetrically enlarged prostate-> Benign Prostatic Hyperplasia -> Obstructing urinary tract outflow

BPH, Vesicoureteral Reflux, Ureteral strictures and Nephrolithiasis

These increase the risk for recurrent urinary tract infections

Inflammation of Renal Interstitium

Elderly, Renal Failure (Oliguria, peripheral edema, elevated serum creatinine)

Fatigue, persistent bone pain, constipation (hypercalcenemia-> nephrocalcinosis)

Anemia and Hypercalcinemia-> diagnosis

Presence of Immunoglobulin Light Chains (Bence Jones Proteins)-> Eosinophilic Intralobular cast formation and obstruction

Results in Tubular Atrophy

Recurrent episodes of gross hematuria, with pharyngitis and RBC casts -> Berger disease

Asymptomatic urinary abnormalities, microhematuria

Increased defective circulating IgA antibodies.

Immune complex depositionon Renal Glomerulus Mesangium

Type III hypersensitivity reaction

Fever, Flank pain, maculopapular rash, and

Urinary abnormalities, hematuria, sterile pyuria, eosinophiluria

Consistent with a Hypersensitivity reaction, NSAID intake

NSAIDs inhibit prostaglandin production

Diffuse interstitial T-Cell and monocyte infiltration

Crystalline Nephropathy, drugs with low urine solubility form Crystals, deposited in renal tubules -> obstruction -> AKI

Eosinophiluria (Urinary eosinophils), Hypersensitivity rxns to PPIs, NSAIDs, antbiotics, Diuretics

Poorly controlled diabetes mellitus

Elevated BUN, Arterial Hypertension, Electrolyte abnormalities, Edema

Microalbuminuria is the earliest diagnostic sign, Urinary albumin

ACE inhibitors can prevent the progression of albuminuria

Costovertebral angle tenderness, nausea, fever,

Ascending bacteria from the bladder

Risk Factors-> Pregnancy, urinary tract obstruction

(BPH, Catheter, Vesicoureteral Reflux)

Immunosuppression, Recurrent UTIs

Secondary to Obesity, heroin use, sickle cell disease, HIV

LM: Segmental Sclerosis of the Glomeruli

(Segmental Sclerosis and Hyalinosis)

Usually leads to End-stage Renal Disease

Most common cause of Nephrotic Syndrome in Hispanic Populations