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Digital Slide Seminar 3: Day 1 (16.30 - 17.00)

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Nephritic syndrome - Dr. Nik Hasimah Nik Yahya​

Case 1:  31 yr old male

•Bilateral leg swelling, abdominal distension and frothy urine x 2 weeks

•24hr urine protein 9gm

•Sr albumin     :  14

•HepB/C, ANA :   negative

Creatinine      : normal

•UFEME            : Prot ++, RBC +

•IF: IgA(3+), C3(1+), mesangial area.

       IgG, IgM and C1q are negative.

 

 

 

Case 2: 23 yr old male

•No known medical illness

•Noted proteinuria on medical check-up

•24hr urine protein : 3.12gm

Creatinine               : 112μmol/l

UFEME                     : Protein3+, RBC+

IF : IgA(2+) and C3(+/-) in mesangium. IgG, IgM and C1q are negative.

 

 

 

Case 3: 4 yr old male

•Abdominal pain, purpuric lesion both lower limbs.

•Generalised eodema

•Macroscopic haematuria

•Nephrotic range protenuria

•Creatinini : 324μmol/l

UFEME      : Protein3+, blood3+

IF : IgA(3+) with prominent capillary wall pattern.  IgM(1+) and C3(+/-). 

        IgG and C1q are negative.

 

 

 

Case 4: 36 yr old female

•SLE since 2015

•First renal biopsy done in 2016, reported as class IV. Treated.

•Now present with generalised swelling and body rash.

•Creatinine 300μmol/l

•? Relapse lupus nephritis

•IF:  Positive(3+) for IgG, IgA, IgM, C3 and C1q.

 

 

 

Case 5: 24 yr old female

•Facial puffiness, bilateral LL oedema and ascited

•Noted hypertension

•UFEME: Protein 4+, RBC 1+

•Creatinine: 299μmol/l

C3 : low

•ANA, ASOT : Negative

•HepB, HepC and HIV : Negative

•IHC: Positive for C3, IgM and C1q. IgG and IgA are negative.

 

 

 

Case 6: 61 yr old lady

•Unwell for a few weeks

•Taking traditional medicine

•Hepatitis C +

•DsDNA+, ANA negative

IF   : No glomeruli

•IHC: IgG, IgM and C3. IgA and C1q are negative

 

 

 

Case 7: 12 yr old boy

•Cough,  sore throat and fever 3 weeks

•Nephritic syndrome

•Dark coloured urine

•UFEME : RBC +++ Protein +++

Creatinine : 400

•Serum albumin 25

?RPGN

IF : IgG(1+), C3(2+); granular along the capillary wall. IgA, IgM and C1q are negative.

 

 

 

Case 8: 44 yr old lady

•Nephrotic-nephritic syndrome.

UFEME : Protein 2+, RBC3+

•24 hr urine prot : 2.6gm

Albumin               : 30

Creatinine            : 68μmol/l

•ANA, HepB/C, HIV are all negative

•IF: C3(3+) granular in mesangial and capillary wall. IgG, IgA, IgM and C1q

       are negative.

 

 

 

Case 9: 45 yr old lady

•Unwell for 1 month

•Presented with acute kidney injury

Creatinine : 415

•UMEFE : RBC++, Protein +

•pANCA positive

•IF: IgG, IgA, IgM, C3 and C1q are all negative.

 

 

 

Case 10: 15 yr old girl

•SLE

•Nephrotic range proteinuria

•Creatinine 120μmol/l

•Low C3 and C4

•IF: IgG(2+), IgA(2+), IgM(2+), C3(3+) and C1q(3+); capillary wall and mesangium

 

 

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