Showing posts with label nephritic syndromes with low complement levels. Show all posts
Showing posts with label nephritic syndromes with low complement levels. Show all posts

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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