CLINICAL NEPHROLOGY GUIDE
CLINICAL NEPHROLOGY
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.
[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?
1) H.I.V.
2) S.L.E.
3) Mixed Cryoglobulinemia.
4) Interferon a. therapy (interferon foot processes).
Q.16.Which renal diseases associated with hemoptysis? (See Q. 25)
A. Renal disease associated with hemoptysis:
1) A.P.O. 2ndry to ARF or CRF.
2) Goodpasture’s syndrome.
3) P.E. or infarct 2ndry to G.N. or RVT.
4) Bacteria Endocarditis.
Q.17. What renal disease associated with skin rashes?
A. Renal disease associated with “skin rashes”:
1) Discoid Lupus⮞ S.L.E.
2) Impetigo ⮞ Post-streptococcal G.N.
3) Angiokeratoma ⮞ Fabry’s disease.
4) Hives ⮞
Ac.
interstitial Nephritis.
Henöch Schönlein pupura.
5) Petechiae ⮞