How can you distinguish glomerular from extraglomerular hematuria?
GLOMERULAR DISEASES
Revise please the abbreviation list on:
https://draft.blogger.com/u/0/blog/post/edit/8610857019469578230/4564412989605988372
Q.148. How can you distinguish glomerular from
extraglomerular hematuria?
A. Glomerular
vs. extraglomerular hematuria:
|
|
“Extraglomerular” |
“Glomerular” |
|
Color (macroscopic): |
Red or
pink. |
Red, smoky brown, or "Coca-Cola“. |
|
Clots |
May be
present. |
Absent. |
|
Proteinuria |
usually
absent. |
May be
present |
|
RBCs morphology |
Normal. |
Dysmorphic |
|
RBCs
casts. |
Absent
. |
May be
present. |
Q. 149.What
is the Hallmark of S.L.E. ?
- Auto-A.B. production of: A.N.A.
& Anti-DNA, incr. Anti-DNA. titre correlate well é clinical
activity.
-
Anti-S.m. A.B. (25% of cases): V. specific to L. nephritis & greatly ass.
é C.N.S. , R. disease., more cutaneous
mnf. &, cardiopulmonary
mnf. & Worse prognosis.
Q.150. What are the renal manifestations of SLE? 👓
A. Renal
Manifestation of SLE:
1)
Proteinuria: 100 %, N.S.: (45-65%).
2)
Hematuria:
Microhematuria: 80 %.
RBCs casts: 10 %.
Macrohematuria 1 %.
3) Cellular casts: (30%).
4) Reduced renal
perfusion: (40-80%):
🠞 RBGN:
10-20%.
🠞AKI: 1%
5) Hypertension: (15-50%).
6) Hyperkalemia: 15 %.
Tubular abnormalities:
(a.Sm.tc.)(60-80%).
Q.151. Mention the major criteria for diagnosis?
- { 4 of Eleven criteria are necessary for Dg.x. of S.L.E. } :
1) Malar
rash.
2) Photosensitivity.
3) Discoid
Lupus.
4) Dermal mamifestation.
5) Oral/nasal ulcers.
6) C.N.S. mamifestation.
7) Serositis (Pleural/Pericardial).
8) Renal mnf. (Persistent Prot. ½ g./d.).
9) Cytopenias.
10)
Arthritis (Non-defomitive).
11)Im/m.
markers:
[ANA-Anti-DNA-
Anti-Sm.].
Q.152. What is Full House in S.L.E. ? What’s its significance?
A. Full House=After booker hands =Christmas Tree
in S.L.E. = Pres. of [Ig.: G+A+M+ C3+ C1q.] altogether in I.F.
study of R. biopsy, of a lupus ptn..
- Full House & C1q
staining
Strongly suggestive of “Lupus Nephritis”.
IF-anti IgG:
The immunofluorescence profile is “full house”, meaning
that IgG, IgA, IgM C3 &
C1q are usually present. This image displays mesangial and
granular loop staining for IgG.
IF-anti-IgA:
Both mesangium & capillary loops are stained. Note the intensity is less
than with anti-IgG.
IF-anti-IgM: Again both
mesangium & capillary loop staining is observed, however there is slightly
more within the mesangium. Note the intensity is also less than that seen with
anti-IgG.
IF-anti-C1q: Staining here’s
v. similar to tht sn é anti-IgG.
Often the intensity rivals tht of anti-IgG.
IF-anti-C3:
C3 is the most
common complement observed in SLE, with C1q almost as common.
Q.153. Give the new classification of
S.L.E.?
i.Minimal mesangial (N. in L.M.).
ii.Mesangial proliferation.
iii.Focal (<50%) proliferative.
iv.Diffuse (>50%) proliferative.
v.Membranous Lupus.
vi.Advanced Sclerosis.
Q. 154. How can you monitor “Lupus Activity”? What are the signs & symptoms of Lupus Flare?
A. - “Parameters of activity”:
(1)
Active urinary sediment (Dysmorphic RBCs. & RBCs casts).
(2)
Hypocomplementemia .
(3)
Anti-DNA titer.
(4)
High E.S.R.
(5)
High C.R.P.
(6)
Circulating im/m. complexes.
(7)
Cytokine & IL. Level.
(8)
Systemic mnf. (fever, fatigue, asthenia).
(9)
Activity features in biopsy: [fibrinoid
necrosis.- Leukocytic
infiltration- Wireloop
deposits.