Consequence of Renal - Glomerular Disease

Def. a group of symptoms indicating immune damage to the sub-endothelium and/or mesangial cells of the Glomerulus → Attract inflammatory cells

Criteria

1. Hematuria +/- RBC Cast
2. Various degree of (4)
   1. Proteinuria (< 3.5)
   2. Generalized Edema
   3. ↑High BP
   4. Decreased eGFR (≥ 60mL/min)

Etiologies (DDx)

Anti-GBM / Goodpasture’s

• Goodpasture’s syndrome (Lung+kidney) : + Hemoptysis, COPD

ANCA (small vessel vasculitis, neutrophil-driven)

• ANCA-Associated Vasculitis:
  • GPA - Granulomatous polyangitis : + ENT involvement
  • MPA - Microscopic Polyangiitis : + Mononeuropathy Multiplex (MM)

<aside>

Immue-complex mediated (Gell and Coomb's Type III (Immune Complex) ) - based on complements

Complement Pathways

• Alternative Pathway (Post Infection)

  • HCV (→ increased [Cryoglobulin

  ](https://oasis-creek-b29.notion.site/Cryoglobulin-26190d2bab6a8055b760f27fcc872b07))

  • Post GAS (10-14 days → immune complex)
  • !IE - Infectious Endocarditis (circulating immune complex)

• Classic Pathway

  • SLE - Lupus </aside>

IgA mediated

• IgA Nephropathy → GIB/Abdo Pain, Palpable Purpura, Arthritis, GN

Idiopathy

• MPGN : Hematuria + HEAVY Proteinuria (> 3.5)

DDx by Lab

](https://oasis-creek-b29.notion.site/Cryoglobulin-26190d2bab6a8055b760f27fcc872b07) (HCV) ‣ (GAS) IE workup | | normal | ↓ | MPGN | ummm | Kidney biopsy | | ↓ | ↓ | SLE - Lupus | Classic Pathway | Lupus work-up | | normal | normal | IgA Nephropathy Goodpasture’s syndrome (Lung+kidney) ANCA-Associated Vasculitis (driven by neutrophil)

| Not about complements | Anti-ANCA, Anti-IgA, Anti-GBM |

Management

• Immunosuppression drugs