secondary glomerulonephritis

8/16/2019 Secondary Glomerulonephritis

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SECONDARY GLOMERULONEPHRITIS


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SYSTEMIC LUPUS ERYTHEMATOSIS

EPIDEMIOLOGY:female\male= 8-13\ 1.

!" a#e $%me&

Male' $()* SLE *a+e )*e 'ame (&,(e&,e %f LN.-%/&0%l. 82" a#e 22 ea#'.

I&,(e&,e: 1.8-4.5 ,a'e'\1!!.!!!.-62"-2!" $(ll *a+e ,l(&(,al #e&al ('ea'e a)

%&'e).-5!" $(ll e+el%7 #e&al ('ea'e /#(&0 )*e(#,%/#'e.


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ETIOLOGY

U&&%$&. R%le: - 0e&e)(,

- *%#m%&al - e&+(#%&me&)al

Ge&e)(,: -(&,#ea'e (&,(e&,e 9e)$ee& m%&%0%)(,)$(&' - 2-16" (&,#ea'e (&,(e&,e (& fam(l(e'.

A m/l)(7l(,() %f 0e&e' a#e (&+%l+e (& 9%)* SLE a&

LN. Alm%') 6! (;e#e&) 0e&e)(, l%,( *a+e 9ee&

a''%,(a)e $()* a& (&,#ea'e #(' %f SLE< (&,l/(&00e&e' (&+%l+e (& -,ell '(0&al(&0< &e/)#%7*(l

f/&,)(%&< a& )%ll-l(e #e,e7)%#'.


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ETIOLOGY

H%#m%&e':- (&,#ea'e (&,(e&,e (& $%me& (&,*(l9ea#(&0 a0e.

-7%')-me&%7a/'al $%me& /&e#e')#%0e&'.

Imm/&e '')em: - ,e#)a(& e>,(e&,(e': C1?< C6< C@. - al)e#a)(%&' /e )% +(#al %# 9a,)e#(al A0'.

E&+(#%&me&)al:

- '/&l(0*) e7%'/#e - UB - ,e#)a(& me(,a)(%&'


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INNATESUSCEPTIILITY:.HLA )7e DR36

.Imm/&%#e0/la)%#0e&e'm/l)(7le

.C%m7leme&) le+el'.H%#m%&al le+el'

ENBIRONMENTALSTIMULI:.UB e7%'/#e

.M(,#%9(al #e'7%&'e.D#/0'

AUTOIMMUNEPROLIFERATION:

.H7e#a,)(+e T ,ell'.I&,#ea'e #a)(%CD@:CD8 T,ell'

.Defe,)(+e(mm/&%,%m7le

,lea#a&,e.Im7a(#e )%le#a&,e

AUTOIMMUNEPROLIFERATION:

.H7e#,a)(+e T ,ell'.I&,#ea'e #a)(% CD@:CD8 T

,ell'.Defe,)(+e IC ,lea#a&,e

.Im7a(#e )%le#a&,e

AUTOANTIODYPRODUCTION:

.A7%7)%'(' a& 'elfe7%'/#e

.Self #e,%0&()(%&.F%#e(0& A-,#%''

#ea,)(%&


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ACR MNEMONIC OF SLE DIAGNOSTIC CRITERIA:

T*e f%ll%$(&0 a#e )*e ACR (a0&%')(, ,#()e#(a (& SLE< 7#e'e&)e (&

)*e SOAP RAIN MD m&em%&(,: Se#%'()(' O#al /l,e#' A#)*#()(' P*%)%'e&'()(+()

l%% ('%#e#' Re&al (&+%l+eme&) A&)(&/,lea# a&)(9%(e' Imm/&%l%0(, 7*e&%me&a e0< 'DNA a&)(-Sm()* JSmK a&)(9%(e'

Ne/#%l%0(, ('%#e# Mala# #a'* D(',%( #a'* F%# (a0&%'(' )*e 7a)(e&) '*%/l *a+e @ %/) %f 11 %f )*e ACR

,#()e#(a. T*(' (el' a 'e&'()(+() %f 82" a& '7e,(>,() %f 2" f%#

SLE.


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DISCOID LUPUS \\\\\\\ MALAR RASH


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PATHOGENESIS

Characteristic:

l%'' %f 'elf )%le#a&,e $()* '/9'e?/e&)a/)%(mm/&e #e'7%&'e'.

Imm/&%l%0(, a&%mal(e':-e,#ea'e C)%)%(, a& '/77#e''%# T,ell'

-(&,#ea'e CD@ T ,ell'< lea(&0 )%7%l,l%&al a,)(+a)(%& %f ,ell'< $()*e,e'' 7#%/,)(%& %f A9' a0a(&')

&/,lea# A0'.


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GLOMERULAR INBOLEBMENT

I) (' a ,la''(, 7#%)%)7e %f (mm/&e,%m7le (&/,e GN.

C*#%&(, e7%'()(%& %f CIC 7la' a ma%##%le (& me'a&0(al 7#%l(fe#a)(%&.

I& (;/'e 7#%l(fe#a)(+e LN )*e e7%'()eC:

N/,lea# A0 DNA *(0* a&(),%m7leme&) >(&0 I0G A9'.


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GLOMERULAR INBOLBEMENT

O&,e CIC a#e e7%'()e:-,%m7leme&) me(a)e ama0e.-a,)(+a)(%& %f 7#%,%a0/la&) fa,)%#'.

-le/%,)e (&>l)#a)(%&.-#elea'e %f 7#%)e%l)(, e&me'.-#elea'e %f +a#(%/' ,)%(&e' #e0/la)(&0

0l%me#/la# ,ell 7#%l(fe#a)(%& a& ma)#('&)*e'('.


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MESANGIAL HYPERCELLULARITY


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NORMAL GLOMERULUS


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DIFFUSE PROLIFERATIBE GN


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MEMRANOUS NP


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IF

Imm/&e e7%'()' a#e f%/& (& all #e&al,%m7a#)me&)'.

I0G< I0A< I0M< a& 6 ,%m7leme&),%m7%&e&)': f/ll-*%/'e. I) (' *(0*l'/00e')(+e %f l/7/'.

Evaluation of renal histology


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Evaluation of renal histology.


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CLINICAL MANIFESTATIONS


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SEROLOGIC ANOMALIES

A9&%#mal a/)%a&)(9%(e': *allma#.- ANA< A&)(-DNA: a&)(-' DNA: *(0*,%##ela)(%& $()* #e&al ('ea'e.

- A&)(-Sm a& a&)(-RNP: 62" %f ,a'e'.A&)(-Sm ,%##ela)e' $()* (&e< CNS<,/)a&e%/' +a',/l()('< ,a#(%7/lm%&a#< a&$%#'e P.

-l%$ C3< [email protected]'e 7%'()(+e BDRL/e )% a&)(-PLa&)(9%(e'.


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DIALYSIS

2-2!" $(ll 7#%0#e'' )% ESRD. Re'%l/)(%& %f 'm7)%m' $()* e)e#(%#a)(&0

#e&al f/&,)(%&< $()* f/#)*e# e,l(&e /#(&0

(al'(':-22" a) %&'e) %f (al'('-1!" af)e# 2 ea#'-!" af)e# 1! ea#'.

T#a&'7la&)a)(%& '*%/l 9e %&e 3-16 m%&)*'af)e# (al'('< f%# )*e a,)(+() %f )*e ('ea'e )%e,l(&e.


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TREATMENT

1-(%l%0(, DMARD: DISEASE MODIFYINGANTI-RHEUMATIC DRUGS:-el(m/ma9< #()/(ma9< IB I0.

6-N%& 9(%l%0(, DMARD:-,,l%7*%'7*am(e< me)*%)#ea)e<m,%7*e&%l(, a,(< ,,l%'7%#(&e

3-C%#)(,%')e#%(' @-A&)(-mala#(al'


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ANCA ASSOCIATEDGLOMERULONEPHRITIS ANCA a''%,(a)e +a',/l()(e' (' a 0#%/7 %f

m/l)(-'')em(, ('ea'e' a;e,)(&0 'mall-)%-me(/m '(e +e''el'.

C*a#a,)e#(e 9 )*e 7#e'e&,e %f A&)(-Ne/)#%7*(l C)%7la'm(, A&)(9%(e' $()*'7e,(>,() f%# e()*e# P#%)e(&a'e-3PR3 %#Mel%7e#%(a'eMPO.

A9'e&,e %# 7a/,() %f (mm/&e ,%m7lee' (&+e''el $all' (' +e# ,*a#a,)e#(')(,< *e&,e )*e&ame Pa/,(-(mm/&e +a',/l()('.


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3 DIFFERENT DISEASE ENTITIES

E%'(&%7*(l(, G#a&/l%ma)%'(' $()* 7%la&0(()(': C*/#0-S)#a/'' S&#%me

M(,#%',%7(, 7%la&0(()('

G#a&/l%ma)%'(' $()* 7%la&0(()(': Qe0e&e#'

G#a&/l%ma)%'(' C%mm%&: - (&+%l+eme&) %f 9l%% + (& (;e#e&)

%#0a&'.- (&amma)%# a& &e,#%)((&0 le'(%&'.

- '%me e0#ee %f #e&al (&+%l+eme&) (& 4!-!".


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ANCAS

ANCA':-ma#e#' f%# Qe0e&e#' 0#a&/l%ma)%'(' a& #ela)e('%#e#'<-a,)%#' (& 7a)*%0e&e'('

C)%7la'm(, 7a))e#&: ,-ANCA: a&)(-7#%)e(&a'e 3.

Pe#(&/,lea# 7a))e#&: 7-ANCA: a&)(-mel%7e#%(a'e Ne/)#%7*(l' e7%'e )% ,)%(&e' '/,* a' TNF< e7#e''

PR3 MPO )*e )a#0e)' f%# ANCA' ANCA' ,)%(&e-7#(me &e/)#%7*(l'=

1-0e&e#a)(%& %f %0e& #a(,al' a&6-#elea'e %f e&me' ,a7a9le %f ama0(&0 9l%%+e''el'.3-e&*a&,e >#m a))a,*me&) )% e&%)*el(al ,ell' lea(&0)% e&*a&,e )#a&'m(0#a)(%& a& ama0e.

I&,#ea'e ANCA=(&,#ea'e &e/)#%7*(l' e0#a&/la)(%&.


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EOSINOPHILIC GRANULOMATOSIS QITH POLYANGIITIS:CHURG-STRAUSS S

C*a#a,)e#(')(,':-*(')%# %f a')*ma %# 'e+e#e alle#0(, #*(&()(' a& 9l%%e%'(&%7*(l(a.

Hea#) (' a ma%# )a#0e) %f )*(' +a',/l()('< a& *ea#)

fa(l/#e (' )*e m%') ,%mm%& ,a/'e %f ea)*. Cl(&(,al ma&(fe')a)(%&':

-ma(&l e)#a-#e&al: 42": ea#< &%'e %# )*#%a).Alle#0(, #*(&()(' a& &a'al 7%l7' 9e(&0 )*e m%')

,%mm%&.-#e&al ('ea'e (' /'/all m(l a& le'' f#e?/e&) )*a& (&%)*e# e&)()(e'< 9/) 'e+e#e ,#e',e&)(, ('ea'e ,a& %,,/#.


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EOSINOPHILIC GRANULOMATOSIS QITH POLYANGIITIS:CHURG-STRAUSS S

U77e# a& l%$e# #e'7(#a)%# )#a,) (&+%l+eme&):-7/lm%&a# &%/le'- ,a+() f%#ma)(%&.-7/lm%&a# *em%##*a0e f#%m al+e%la# +a',/l()('

Re&al a9&%#mal()(e' a#e 7#e'e&) (& a9%/) %&e?/a#)e# %f 7a)(e&)' $()* CSS. T*e 7#e+a(l(&07(,)/#e (' ANCA-a''%,(a)e &e,#%)((&0,#e',e&)(, 0l%me#/l%&e7*#()(' *%$e+e#< %)*e#

f%#m' %f &e7*#%7a)* al'% ma %,,/#. O/),%me a& l%&0-)e#m f%ll%$-/7 /'/all a#e

0%%.


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QEGENER GRANULOMATOSIS OR GRANULOMATOSISQITH POLYANGITIS

Small a& me(/m +e''el +a',/l()('

,-ANCA !" %f 7a)(e&)' /#(&0 )*e ('ea'e

T#(a:-'')em(, &e,#%)((&0 +a',/l()('

-&e,#%)((&0< 0#a&/l%ma)%/' (&amma)(%& %f )*e#e'7(#a)%# )#a,)-Ne,#%)((&0 GN

Sl(0*) male 7#e7%&e#a&,e.

Pea a0e: @!-2! ea#'.

Pa/,(-(mm/&e RPGN ,#e',e&)(, GN a) all a0e'< '7e,(all(& )*e ele#l.

HLA DR6< 4< DR1.


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SYMPTOMS

At Onset Total ENT 42"2" L/&0 2! 82 V%(&)' 3! 4! Fe+e# 62 2! W(&e 6! 42 C%/0* 6! 2! Ee 12 2! S(& 12 @2

Qe(0*) L%'' 1! 32 Ne#+%/' S')em Ce&)#alPe#(7*e#al 1!12

O&e-)*(# %f 7a)(e&)' ma 9e $()*%/) 'm7)%m' a) %&'e) %f ('ea'e


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1! CLASSIFICATION

Na'al %# %#al (&amma)(%& - De+el%7me&) %f 7a(&f/l %#

7a(&le'' %#al /l,e#' %# 7/#/le&) %# 9l%% &a'al (',*a#0e

A9&%#mal ,*e') #a(%0#a7* >&(&0' - C*e') #a(%0#a7*'*%$(&0 &%/le'< >e (&>l)#a)e'< %# ,a+()(e'

U#(&a# 'e(me&) - M(,#%*ema)/#(a 2 #e 9l%% ,ell'JRC'K 7e# *(0*-7%$e# >el JHPFK %# RC ,a')' (& /#(&e'e(me&)

G#a&/l%ma)%/' (&amma)(%& %& 9(%7' - H(')%l%0(,,*a&0e' '*%$(&0 0#a&/l%ma)%/' (&amma)(%& $()*(& )*e$all %f a& a#)e# %# (& )*e 7e#(+a',/la# %# e)#a+a',/la#a#ea a#)e# %# a#)e#(%le

A 7a)(e&) (' 'a( )% *a+e )*e ('ea'e (f 6 %/) %f @ ,#()e#(a

a#e 7#e'e&).


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PATHOLOGY

F%,al 'e0me&)al &e,#%)((&0 a&,#e',e&)(, GN

Ne,#%)((&0 ,*a&0e' a#e 'e0me&)al (&

&a)/#e. I&)#a,a7(lla# )*#%m9%'('.

G#a&/l%ma)%/' ,#e',e&)' ma 9e

7#e'e&) (& 12-2!" %f ,a'e'. If: l%$ : 7a/,(-(mm/&e.


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Ma''(+e &e,#%'(' ('/'/all a''%,(a)e)% (;/'e

,(#,/mfe#e&)(ale)#a,a7(lla#7#%l(fe#a)(%&. F#%m a,l(&(,al 7%(&) %f

+(e$< )*e 7a)(e&) ('a;e,)e 9 #a7(l7#%0#e''(+e #e&alfa(l/#e.


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A 'e0me&)ale)#a,a7(lla##ea,)(%& (& ,l%'e7#%(m() %f )*e&e,#%)((&0 le'(%& ('m%#e f#e?/e&)l7#e'e&). T*e#ema(&(&0 7a#) %f )*e

)/f)< &%) a;e,)e 9)*e le'(%&< a77ea#',%m7le)el &%#mal.


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The massivecircumferentialleuoc!te in"ltration#ives a $icture of%#lomerular#ranuloma&lielesion'(

This feature:&)e#ener*s#ranulomatosis&Anti&G+M&,ol!arteritis


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PATHOGENESIS

U&&%$&.

A&%mal(e' (& 9%)* ,ell/la# a& */m%#al(mm/&().

R%le %f ANCA (& 9%)* (&e a& l/&0(&+%l+eme&).


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CLINICAL SYMPTOMS


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RESPIRATORY TRACT

4!-8!" $(ll *a+e URT >&(&0' a)7#e'e&)a)(%&.

S(&/'()('ma(lla#< #*(&()('< $()* 9l%%

a& 7/#/le&) (',*a#0e. 42": l%$e# RT ('ea'e: ,%/0*< '7/)/m<

'7&ea< al+e%la# *em%##*a0e<

*em%7)'('< a& 7le/#()(, 7a(&. CT-',a&: &%/le' ,a+()a)(%&'

7le/#al e;/'(%&.


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TREATMENT

INDUCTION: C,l%7*%'7*am(e *(0* %'e ')e#%(' (' )*e )#ea)me&) %f

,*%(,e. R()/(ma9 *(0* %'e ')e#%('

Me)*%)#ea)e *(0* %'e ')e#%(' Pla'ma e,*a&0e (& #a7(l 7#%0#e''(+e #e&al ('ea'e

MAINTENANCE:-aa)*(%7#(&e %# me)*%)#ea)e

L%&0 )e#m '/#+(+al:

O+e#all< )*e 1!-ea# '/#+(+al #a)e #a&0e' f#%m 42-88".


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POLYARTERITIS NODOSA

T*e ('ea'e *a' 9ee& (+(e (&)%:- ,la''(, 7a))e#& $()* a '')em(, &e,#%)((&0+a',/l()(' 7#(ma#(l a;e,)(&0 me(/m-'(e a&m/',/la# a#)e#(e'< %f)e& a) 9#a&,* 7%(&)'<

7#%/,(&0 le'(%&' %f +a#(&0 a0e' $()* f%,ala&e/#'m f%#ma)(%&.-m(,#%',%7(, 7%la&0(()(' $()* a &e,#%)((&0(&amma)(%& %f 'mall a#)e#(e'< +e(&'< a&,a7(lla#(e' (&+%l+(&0 m/l)(7le +(',e#a< (&,l/(&0l/&0 a& e#m(' a& 7#%/,(&0 le'(%&' %f '(m(la#a0e< /'/all $()*%/) a&e/#'m'.


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CHARACTERISTICS

ANCA

Pa/,(-(mm/&e 'e0me&)al &e,#%)((&0a& ,#e',e&)(, GN. P#e+ale&,e %f #e&al

('ea'e: 5@-1!!". Male\female= 6.2\1.

Pea a0e: 2!-5! ea#'.

HLA-32.


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MICROSCOPIC PA

T*e m%') 7#%m(&e&) *(')%l%0(,al >&(&0(' )7(,all a f%,al 'e0me&)al &e,#%)((&00l%me#/l%&e7*#()(' $()* ,#e',e&)'

a;e,)(&0 f#%m fe$ )% ma& 0l%me#/l(. T*e#e (' f%,al e')#/,)(%& %f )*e

0l%me#/la# 9a'eme&) mem9#a&e

a''%,(a)e $()* 7%lm%#7*%&/,lea#(&>l)#a)(%&< a& e7%'()(%& %f >9#(& $()*(&)*e )/f) a& aa,e&) %$ma& '7a,e.


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TREATMENT

S)e#%(' a& (mm/&%'/77#e''(+e me(,a)(%&' f%#m)*e 9a,9%&e %f )*e#a7. C*%(,e %f a0e&)' e7e&'%& 'e+e#() %f )*e ('ea'e.

Se+e#() a& %/),%me %f 7%la#)e#()(' &%%'a PAN

*a' 9ee& em%&')#a)e )% 9e e7e&e&) %& )*ef%ll%$(&0 2 fa,)%#'< &%$& a' )*e 2-fa,)%# ',%#e FFS:1-P#%)e(&/#(a 0#ea)e# )*a&1 06-Re&al (&'/,(e&, ,#ea)(&(&e 1@! Xm%lL

3-Ca#(%m%7a)*@-GI ma&(fe')a)(%&'2-CNS (&+%l+eme&)


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MORTALITY

Q*e& lef) /&)#ea)e< )*e 2-ea# '/#+(+al#a)e %f PAN (' 13".

Nea#l 2!" %f 7a)(e&)' (e $()*(& )*e >#')

3 m%&)*' %f %&'e). C%#)(,%')e#%( )#ea)me&) (m7#%+e' )*e 2-

ea# '/#+(+al #a)e )% 2!-5!".

Q*e& )*e ')e#%( (' ,%m9(&e $()* %)*e#(mm/&%'/77#e''a&)'< )*e 2-ea# '/#+(+al#a)e ma (&,#ea'e )% 0#ea)e# )*a& 8!".


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TREATMENT

Q*e& &% 9a 7#%0&%')(, fa,)%#' a#e 7#e'e&)(.e.< FFS =!< 7#e&('%&e ,a& 9eam(&(')e#e a' a '(&0le a0e&).

C,l%7*%'7*am(e (' (&(,a)e f%# 7a)(e&)'$()* 7%%# 7#%0&%')(, fa,)%#' FFS !.

N9: '7e,(al )#ea)me&) $*e& HB a''%,(a)e: -,,l%7*%'7*am(e ')e#%('

-7la'ma7*e#e'(' -a&)(+(#al )#ea)me&)


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GOODPASTURE SYNDROME=ANTI-GM

A&)(-GM ('ea'e (' a& a/)%(mm/&e ('%#e#,*a#a,)e#(e 9 a/)%a&)(9%(e' (#e,)e a0a(&'))*e 0l%me#/la#al+e%la# 9a'eme&) mem9#a&e.

T*e a/)%a&)(9%(e' 9(& )% )*e(# #ea,)(+e e7()%7e'

(& )*e 9a'eme&) mem9#a&e' a& a,)(+a)e )*e,%m7leme&) ,a',ae< #e'/l)(&0 (& )(''/e (&/#. T#(a:

1- A&)(-GM

6- P/lm%&a# *em%##*a0e3- P#%l(fe#a)(+e< ,#e',e&)(,< GN. T*e 7/lm%&a# *em%##*a0e ma 7#e,ee< %,,/#

,%&,/##e&)l $()*< %# f%ll%$ )*e 0l%me#/la#

(&+%l+eme&).


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GOODPASTURE SYNDROME

I& m%') 7a)(e&)'< )*e a/)%a&)(9% (& G%%7a')/#e'&#%me (' (#e,)e a0a(&') )*e &%&-,%lla0e&%/' %ma(&1 %f )*e al7*a3 ,*a(& %f )7e IB ,%lla0e&

T*e Z3IB ,*a(& (' e7#e''e (&: al+e%la# M< M %f )e')('< (&&e#

ea#< )*e ee a& ,*%#%( 7le/'.

I0G a&)(9%(e' 9(& )% )*e'e mem9#a&e' a& a,)(+a)e )*e ,la''(,al

7a)*$a %f ,%m7leme&)< $*(,* ')a#) a &e/)#%7*(l e7e&e&)

(&amma)(%&.

T*e )()e# %f ,(#,/la)(&0 a&)(9%(e' *a+e a 7#%0&%')(, (m7%#)a&,e.

T*e#e (' a& (&,#ea'e 7#e+ale&,e %f HLA-DR1-12 a&DR1[12!1< DR1[12!6 .


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ETIOLOGY

A& (&()(al (&'/l) )% )*e 7/lm%&a# +a',/la)/#e (' #e?/(#ef%# e7%'/#e %f )*e al+e%la# ,a7(lla#(e' )% )*e a&)(-GMa&)(9%(e'. P#e('7%'(&0 fa,)%#' f%# '/,* e7%'/#e (&,l/e)*e f%ll%$(&0:

Ge&e)(, 7#e('7%'()(%& E7%'/#e )% %#0a&(, '%l+e&)' %# *#%,a#9%&' Sm%(&0 I&fe,)(%& C%,a(&e (&*ala)(%& E7%'/#e )% me)al /')' I& )*e (&e< )*e#e a#e #e7%#)' %f a&)(-GM ('ea'e af)e#

l()*%)#(7' )#ea)me&) %f #e&al ')%&e'. T% 9e ,%&>#me.


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CLINICAL FEATURES

GN me(a)e 9 GM-a&)(9%(e' ('(&f#e?/e&): 1-6".

6 7ea' %f %,,/##e&,e :-%/&0e# male'

- ele#lfemale'9/)< () ,a& %,,/# a) a& a0e< (& e()*e#

'e. A& /77e# #e'7(#a)%# )#a,) (&fe,)(%&

7#e,ee' )*e %&'e) %f ('ea'e (& 6!-

5!" %f ,a'e'.


53/59

CLINICAL FEATURES

M%') ,%mm%& e)#a#e&al ma&(fe')a)(%&:7/lm%&a#.-,%/0*< '7&ea< *em%7)'('.

-(& 3\@ %f ,a'e'< 7/lm%&a# *em%##*a0e7#e,ee' %# (' ,%(&,(e&) $()* 0l%me#/la#('ea'e.

C%&')()/)(%&al 'm7)%m': $ea&e''<

fa)(0/e< $e(0*) l%''< ,*(ll'< fe+e#< '(& #a'*<*e7a)%-'7le&%me0al< a#)*#al0(a'.


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RENAL PRESENTATION

A,/)e &e7*#()(, %# RPGN (& " %f ,a'e'. HTN: %&l 6!" a#e *7e#)e&'(+e a)

7#e'e&)a)(%&< /'/all a la)e e+e&) /e )%

a+a&,e #e&al fa(l/#e a& /( #e)e&)(%&. Eema

Hema)/#(a

A,)(+e /#(&a# 'e(me&) De,#ea'e #e&al f/&,)(%&. 1\3 %f 7a)(e&)'

*a+e &%#mal #e&al f/&,)(%& a) %&'e).


55/59

LA

U#(&al'(':-a,)(+e /#(&a# 'e(me&) $()* #e ,ell'a& #e ,ell ,a')'.

-7#%)e(&/#(a.-A&)(-GM a#e 7#e'e&) (& !" %f,a'e'.

-ANCAm%')l MPO (& 6!-32" %f ,a'e'.


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PATHOLOGY

LM 7a)(e&)' $()* m(l ,l(&(,al (&+%l+eme&):-f%,al< 'e0me&)al 7#%l(fe#a)(+e

0l%me#/l%&e7*#()('. M%') ,%mm%&:

- (;/'e ,#e',e&)(, 0l%me#/l%&e7*#()(' (&+%l+(&0%+e# 2!" %f 0l%me#/l(< $()* e/9e#a&),(#,/mfe#e&)(al ,#e',e&)'.

T*e )7(,al >&(&0 (& (#e,) (mm/&%/%#e',e&,e

m(,#%',%7 (' a:l(&ea# ')a(&(&0 %f I0G al%&0 )*e GM< %f)e&a,,%m7a&(e 9 C3 e7%'()(%&.


57/59


58/59

COURSE AND TREATMENT

P#%0#e''(+e #e&al fa(l/#e lea(&0 )%/#em(a.

If )#ea)me&) (' ')a#)e ea#l (& )*e

,%/#'e %f )*e ('ea'e 7a)(e&)' ma#e0a(& ,%&'(e#a9le (&e f/&,)(%&.

Pla'ma7*e#e'(' ma *a+e a #ama)(,

e;e,) (& #e+e#'(&0 7/lm%&a#*em%##*a0e a& #e&al ('ea'e $*e&/'e ea#l (& )*e ,%/#'e (& ,%m9(&a)(%&

$()* (mm/&%'/77#e''a&)'.


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TREATMENT

S)a&a# )#ea)me&) )%a ,%&'(') %f )*e,%m9(&a)(%&:-*(0* %'e ')e#%('-,,l%7*%'7*am(e

-7la'ma e,*a&0e. T*e #a)(%&al 9e*(& ')e#%(': (' )% *al) )*e

&e/)#%7*(l #(+e& (&amma)(%&.

T*e #a)(%&al 9e*(& ,,l%7*%'7*am(e (' )% ')%7

a&)(9% f%#ma)(%& T*e #a)(%&al 9e*(& 7la'ma7*e#e'(': (' )% #em%+e

,(#,/la)(&0 a&)(9%(e'.

secondary glomerulonephritis

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