CLINICAL NEPHROLOGY GUIDE
Q.11. What non-immune complex-mediated disease can cause low complement level?
A. Non-im/m. complex-mediated R. disease 🠞 C.P. that mimic a primary G.N. include: 👌
1) Atheroembolic R. dis.: H.C. is seen only during active phase of disease.
2) HUS/TTP: 50% ⮞ compl. activated by endothelial damage or bacterial toxin.
3) Severe sepsis, Ac. pancreatitis & advanced liver disease⮞H.C.
Q.12. So, what are other diseases associated with normal complement?
A. H.C. is us. due to C. activation by im/m. depostion é rate > that new complement proteins synthetize. In comp., slower rate of C. activation occur with :
- Focal G.N. (such as IgA Np.).
- Fibrillary G.N.
- M.N., complement us. Normal excep. in M.N. due to lupus or HBV .
- Anti-glomerular BM. AB. dis.
- Wegener's granulomatosis.
- Polyarteritis nodosa.
- Henoch-Schönlein purpura. etc..
Q.13 How to gain an access to isolated proteinuria?
A. Start é Quantitate Prot. excretion & GFR: either Normal or Reduced:
[I] Normal GFR + Non-nephrotic range prot:
1. Recumbent overnight: -ve dipstick= Orthostatic Prot & No further action.
2. Persistenat fixed Prot: Reassess at 6-12 m. (GFR & ur. Prot & B.P.):
a) Normal all à assess annually.
b) BP abnormality +🠉Prot Serology & U/S. Consider R. biopsy.
GFR: Serology & U/S.
Consider: R. biopsy.
Q.14.What kidney disease associated with arthritis?
A. Renal disease associated with arthritis:
1) Lupus Nephritis.
5) Henöch Schönlein pupura.