After some discussion from the NEJM’s Image Challenge from several weeks ago. I decided to very quickly discuss the difference between Terry’s nails, Lidnsay’s nails, and Meurcke’s bands. The lunula (latin for “little moon”) is the hypopigmented semi-circle located at the base of the nail bed and is abnormal or obliterated in several conditions. …
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Commonly in the work up of nephrotic syndrome we think serum complements are ordered because they help us narrow down our differential diagnosis. Here is a quick reminder of which conditions cause what. As a quick reminder remember that classical activation involves the binding of C1q to the Fc region of IgG and IgM…
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1.) How many histologic stages of Membranous Nephropathy are there? A. 2 B. 3 C. 4 D. 5 Discussion: Four stages. Great LM and EM can be found here (AKJD Atlas). Stage I: Subepithelial deposits with little change to GBM, but extensive foot process effacement Stage II: Basement membrane “spikes” form between immune-complex Stage…
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1.) How many histologic stages of Membranous Nephropathy are there? A. 2 B. 3 C. 4 D. 5 2.) The stages correlate with the clinical manifestations of MN. A. True B. False 3.) Which of the following are podocyte antigens? A. suPAR B. Neutral endopeptidase (NEP) C. Paxillin D. Phospholipase A1 Receptor (PLA2R)…
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At the moment we don’t have clinically available serologic markers of disease activity for membranous nephropathy (PLA2R is in the pipeline) so we have to rely on clinical factors to predict prognosis. Above is a chart that lists the factors associated with Progression and strength of the associated (PPV). Source: Comprehensive Clinical Nephrology, 4th Edition.
“What should I eat?” And “Should I avoid protein since I’m losing it in my urine?” These are questions that I often hear my patients with nephrotic syndrome ask. So today I decided to do a quick review to answer those questions in the clinic and on the wards. Sodium Sodium restriction has been shown…
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This week we had an interesting patient that present several months ago with HIV/AIDS with very low CD4 count off HAART for the last several years. The patient presents with nephrotic syndrome with lower extremity edema, normal renal function, and 13 grams proteinuria/day. Renal biopsy was done and showed membranoproliferative pattern with “full house”…
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