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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 diseaseH.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 :

  1. Focal G.N. (such as IgA Np.).
  2. Fibrillary G.N.
  3. M.N., complement us. Normal excep. in M.N. due to lupus or HBV .
  4. Anti-glomerular BM. AB. dis.
  5. Wegener's granulomatosis.
  6. Polyarteritis nodosa.
  7. 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.

 [II.] Reduced GFR:    Serology  & U/S.   Consider: R. biopsy.

Q.14.What kidney disease associated with arthritis?

A. Renal disease associated with arthritis:

1)               Lupus Nephritis.

2)               Amyloidosis.

3)               Sarcoidosis.

4)               Cryoglobulinemia.

5)               Henöch Schönlein pupura.

Q. 15. Enumerate the causes of “Finger Prints” (tubulo-reticuler inclusions) in renal histopathology?