NEFROLOGISK KLINIK P, RIGSHOSPITALET

Slides:

Advertisements

Similar presentations

Acute Glomerulonephritis

Advertisements

SYSTEMIC LUPUS ERYTHEMATOSUS (SLE)

Immune Complex Nephritis.

Glomerular Diseases Dr. Atapour Differential diagnosis and evaluation of glomerular disease.

Case Presentation Dr Mohan Shenoy Consultant Paediatric Nephrologist Royal Manchester Children’s Hospital.

Case D 1 Age 37 M HIV for 17 years 1 week history of diarrhoea and fever Abrupt onset of oedema and oliguria Homosexual Teenage drug abuse.

Nephrotic Syndrome Dr. Raid Jastania. Causes Minimal Change disease (lipoid nephrosis) Membranous glomerulonephritis Focal segmental glomerulosclerosis.

This lecture was conducted during the Nephrology Unit Grand Ground by Medical Student under Nephrology Division under the supervision and administration.

U Lupus.Nephrotic syndrome now. Normal creat.  C3/C4, ANA +, ? Membranous ?antiphospholipid Ab syndrome.

Acute Glomerular Nephritis

Patient developed acute and chronic renal failure in 1999 associated with a renal stone. History, and a diagnosis of chronic pyelonephritis. She was started.

Urinary System Tutorial Glomerulonephritis

This lecture was conducted during the Nephrology Unit Grand Ground by a Sub-intern under Nephrology Division, Department of Medicine in King Saud University.

U and U # U y.o. male ? Wegener’s.

U # yr old woman with sinusitis,arthritis pulmonary hemorrhage,microscopic hematuria Proteinuria 2.5g/day (+) pANCA,Cr 127 ANA(+). Anti.

Immune Complex Nephritis

Effector mechanisms of humoral immunity 1  Physiologic function of Abs is defence against extracellular microbes and microbial toxins  Defects in Ab.

KIDNEY LECTURE 2. Glomerular diseases. Glomerular structure Arterioles Capillaries Mesangium (“between capillaries”) Urinary space surrounds glomerulus.

U # Creat 250 Nephritic urine ? Crescentic GN.

Clinical Course of FSGS.

U # y.o. F New diagnosis of lupus Normal creatinine.

Immunology Unit Department of Pathology College of Medicine King Saud University.

U # y.o. female with pneumonia  creatinine proteinuria very low C3, C4.

Glomerulonephritis Brian S. Pavey, DO, MS. Presentation Sudden onset – Hematuria – Hypertension – Edema – Acute kidney injury.

Associate professor of Internal Medicine

And Review of Acute nephritis Syndromes. Karyomegalic Tubulointerstitial Nephritis  Symptoms: Recurrent Pneumonias Renal failure leading invariably to.

U #009N Recurrent edema with most recent episode proteinuria with creat > 300.

Hazem.K.Al-Khafaji FICMS Department of internal medicine College of medicine Al-Qadissyia University.

U # Proteinuria. 52 year old female followed for dextrocardia and Tetralogy of Fallot complicated by pulmonary hypertension and right.

U # Cad Tx 15 years ago Recent  creatinine with mild proteinuria No RAS.

U # IgG- strong coarsely granular capillary loop staining,mild to moderate granular peritubular staining IgA- moderate mesangial staining.

U Chronic renal failure secondary to ? Hepatitis C.

U Clinical History A 53 year old man who had very little or no medical care in the past, presents to ER with the only complaint of insomnia.

U # Chronic renal failure – secondary to IgA nephropathy. Deceased donor kidney transplant – August Complicated by delayed graft.

Clinical Immunology Overview and use of the Laboratory.

AOA NEPHROLOGY REVIEW March 18, A 29 year old woman is being evaluated to find the cause of her urine turning a dark brown color after a recent.

Causes of membranous nephropathy 신장내과 R 3 김경엽. Membranous nephropathy and focal glomerulosclerosis –Most common causes of the nephrotic syndrome in nondiabetic.

“Monitoring Systemic Lupus Erythematosus” Andres Quiceno, MD Presbyterian Hospital of Dallas.

U # LRD kid tx March/99 Original Dis IgA.

Systemic lupus erythematosus

Nephrology Pathology Rounds Oct 21/05

Proteinuria in a Renal transplant Recipient

53 yo female referred for elevated SCr (178 mmol/l, 28 ml/min) and change in symptoms….? connective tissue disease Dx of hypocomplementemic urticarial.

“Systemic Lupus Erythematosus” Renal features

SYSTEMIC LUPUS ERYTHEMATOSUS (SLE) BY DR WAQAR MBBS, MRCP ASST. PROFESSOR.

U # y.o. male Hemoptysis, pulmonary haemorrhage

Table 1.2.1: Total number of renal biopsies by centres, 2005 – 2012

U # /121 Cad Tx 14/05/2004 Creatinine early December US normal.

Immune Complex Nephritis

U # year old female Artheritis with increased creatinine, proteinuria, hematuria. ? Lupus.

Autoimmune diseases Ali Al Khader, M.D. Faculty of Medicine

Dr S Chakradhar.

ACUTE & CHRONIC GLOMERULONEPHRITIS

Clinical Features. This disorder usually presents either with the

Glomerular pathology in systemic disease

Volume 82, Issue 7, Pages (October 2012)

Volume 78, Issue 2, Pages (July 2010)

Sanjeev Sethi, Carla M. Nester, Richard J.H. Smith

IgA Nephropathy Southwest Nephrology Symposium February 24th 2018.

Volume 82, Issue 7, Pages (October 2012)

Nephrology cases Dr . Hayam Hebah.

Nephritic syndrome.

C3 glomerulopathy: what's in a name?

CLINICAL PRESENTATION OF GN

Department of Pathology

Antibody-guided diagnosis and treatment algorithm for primary membranous nephropathy (PMN). Antibody-guided diagnosis and treatment algorithm for primary.

Absolute renal biopsy diagnosis frequencies of the most common glomerular disease subtypes according to patient age category. Absolute renal biopsy diagnosis.

Relative renal biopsy diagnosis frequencies of the most common glomerular disease subtypes according to patient age category and typical mode of clinical.

Presentation transcript:

NEFROLOGISK KLINIK P, RIGSHOSPITALET Ground rounds with case presentations Nordic Society of Nephrology 34th Biennal Congress Malmö Sept 22nd 2017 Wladimir Szpirt Department of Nephrology Rigshospitalet, Copenhagen, Denmark

17 yrs. old boy admitted by GP in April 2017 for nephrotic syndrome 17 yrs. old boy admitted by GP in April 2017 for nephrotic syndrome. We found normal creatinine, proteinuria 10 g/day, albumin 14 g/L. During childhood many infections especially respiratory, was coughing, had 2x hemoptysis, After parkourt training legs swallowing for 1 month.

Renal biopsy & lab. tests Immune complex mediated membrano proliferative GN with membranous component and SLE like nephritis, class IV-G + class V, full-house deposits of immunglobulins. b. 2 positive results for ANA. negative for anti-DNA & anti-Sm antibody. Low blood concentration of C3. DAT neg. No lymphopenia. Neg. Hepatitis B & C, HIV Neg. anti-phosplipase A2 receptor Abs (PLA-2R)

Diagnostic evaluation: SLE based on SLICC: Renal biopsy SLE ANA-positive. Low C3 Extra renal: no other symptoms from cardio-pulmonal, no athralgias or myalgias, no photosensitivity, no skin symptoms, no mucous ulcerations. Look for immune defect as he had spontanous low Ig G, has normal B-T- cells and MBL (mannose binding lectin)

Plasma creatinine april – september 2017

Albumin in G/L during immunosupression

Proteinuria in g/d during immunosuppression

Membrano proliferative GN (MPGN) Diagnosis based on biopsy. Typically proteinuria up to nephrotic syndrome. Creatinine can be increased. Before type I-III based on electron microscopy. Now new classification based on immune deposits - not seen in our pt. Immune complex mediated MPGN IgG & complement complexes in biopsy, low C4 and low/normal C3 in blood. Can be primary (idiopatic) or more often secundary to autoimmun sygdom (SLE, RA or Sjøgrens), infection (hepatitis B/C, endocarditis, shunt nephritis, abscesses) Malignancy (typically plasmatic cell diseases) Complement mediated MPGN (C3G) Deposition of C3 i glomerula with or without Ig-deposition. MPGN without Ig/complement Rare typically secondary to chronic MPA, Prothrombotic conditions transplant glomerulopathies

C1q C3c C1q C3c

IgA C4c IgG IgM

kappa kappa lambda