Thursday, March 4, 2010

29 - Differential diagnosis of Nephritic syndromes based on Complement levels

*Nephritic syndromes with low complement levels :
   (Immune complex glomerulonephritis)
- Idiopathic proliferative glomerulonephritis
- Crescentric glomerulonephritis
- Membranoproliferative glomerulonephritis
- Lupus nephritis
- Cryoglobulinemia
- Bacterial endocarditis
- Shunt nephritis
- Post infectious glomerulonephritis (post streptococcal)

*Nephritic syndromes with Normal complement levels :
- Anti GBM disease : Good pasture syndrome
- Pauci immune glomerulonephritis : Wegener's granulomatosus and Microscopic PAN.
- Immune complex mediated : Henoch schonlein purpura, IgA nephropathy and Fibrillary glomerulonephritis.

*An important point to be noted is that, in Post streptococcal glomerulonephritis : Serum C3 levels are depressed within 2 weeks, however these usually return to normal levels within 6 to 8 weeks. Persistent depressed levels after this period should suggest another cause such as presence of C3 nephritic factor (Membranoproliferative glomerulonephritis).

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Given below are two MCQs which appeared in the AIPGME 2004 paper related to the above topic.

1Q: Serum C3 is persistently low in all of the following except :
a. Post streptococcal glomerulonephritis
b. Membranoproliferative glomerulonephritis
c. Lupus nephritis
d. Glomerulonephritis related to bacterial endocarditis


2Q: All of the following are associated with low complement levels except
a. Lupus nephritis
b. Mesangio capillary glomerulonephritis
c. Diarrhea-associated HUS
d. Post-infectious glomerulonephritis

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