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Final med, Nephritic syndrome

Nephritic syndrome, Vasculitis
by

Mark Little

on 28 November 2016

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Transcript of Final med, Nephritic syndrome

15 per million/year
250/million prevalence Nephritic Syndrome C5a antagonism Huugen et al, Kid Int (2007) 71, 646 Thank you for
your attention

mlittle@tcd.ie Mr MC, a 51yo carpenter
Presented with right sided knee pain
Had 2 episodes of sinusitis over past 4 months
Treated with penicillin - hives and migratory arthritis Initial investigations:
Urinalysis normal
WCC 12,000 per cu mm
Underwent surgical exploration of the knee
Loose meniscus and inflamed synovium
Pain continued in the knee
At 2nd op, actinomyces was grown from joint fluid 6 months later...
Presented with migratory arthritis, fever, left sided proptosis and epistaxis
Urinalysis: some red cells
X-ray: pansinusitis and new right basal infiltrates Lupus erythematosus suspected, but no LE cells
Treated with ACTH, with improvement in joint symptoms
Developed frank haematuria and exophthalmous worsened
Globulin level 3.6g per cent
Widespread petechial rash (normal clotting mechanism)
Blood urea nitrogen rose to 200mg pre cent MC died on 30th June 1952
o k
n c Nephritic syndrome - Clinical
The glomerular filtration barrier
Pathogenesis
Rapidly progressive glomerulonephritis
ANCA-associated vasculitis Urinary space Blood Mesangium GBM Endothelial cells Epithelial
cells Urine / Filtrate Blood IgA Nephropathy The commonest glomerulonephritis in the world Capillary lumen Urinary space Granulomatosis with polyangiitis -
Anti-Proteinase 3 antibodies
Microscopic polyangiitis -
Anti-Myeloperoxidase antibodies Infection
Marrow suppression (leukopenia)
Diabetes
Loss of bone density
Haemorrhagic cystitis
Full transcript