DR Medhat MRCP

Differentiating between IgA nephropathy and post-streptococcal glomerulonephritis
Post-streptococcal glomerulonephritis is associated with low complement levels.
Main symptom in post-streptococcal glomerulonephritis is proteinuria (although
haematuria can occur)
There is typically an interval (2-4 weeks) between URTI and the onset of renal
problems in post-streptococcal glomerulonephritis
Rapidly progressive glomerulonephritis (crescentic GN)
- Rapid loss of renal function ( > 50 % GFR over 3 months) .
- Often presenting as ARF
Causes :
1) Type I RPGN (direct Abs against type IV collagen of glomerular&/or alveolar BM)
Acount for 20 % of RPGN
Anti-GBM disease : if confined to the kidney
Goodpasture's disease : if affecting both kidney & lung.
2) Type II RPGN (immune complex deposition in the glomerulus)
SLE
Acute diffuse proliferative GN e.g post infectious.
IgA nephropathy
HSP
3) Type III RPGN (ANCA positive vasculitis or pauci-immune vasculitis)
Wegener`s granulomatosis (c-ANCA)
Churg-Strauss syndrome
Microscopic polyangitis
Idiopathic renal limited crescentic GN.
Pathology : cellular, fibrocellular crescents.
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