Causes of Rapidly Progressive Glomerulonephritis - USMLE Forums
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Old 09-13-2010
ashishkabir's Avatar
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Kidney Causes of Rapidly Progressive Glomerulonephritis

Hi there - I thought I'd share this in case this helps someone - Rapidly progressing glomerulonephritis comes in 3 types:

Type 1 involves anti glomerulo basement membrane antibodies and includes Goodpastures

Type 2 involves immune complex deposition and so a lumpy bumpy pattern and can be sequelae for Post strep glomerulonephritis / SLE / IgA nephropathy and Henoch Schloein Purpura

Type 3 is Pauci Immune and involves a lack of immune complexes (Ig) or C3 in the renal biopsy and can be accompanied by URI symptoms.

My question is if you have renal symptoms and hematuria how are you supposed to distinguish between Pauci immune and Goodpastures if they don't give you a biopsy? Do we need to know the treatment or labs that distinguish between these types?
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Old 09-13-2010
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They won't ever ask you to differentiate between the two without giving you the biopsy, because this is the situation in real life practice.
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Old 09-13-2010
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Although you may need the biopsy for a definite diagnosis, I think you should still know a bit about their presentations. Goodpasture's present with hematuria and hemoptosis ( because the antibodies that attack the glomerular basement membrane in the kidney's also attck basement membranes in the lung). The Pauci-immune RPGN's are mostly necrotizing vasculitis such as Wegener's, Churg- Strauss and microscopic polyangiitis, and they also have hematuria and hemoptosis, but they also have pupura and ANCA. Also, it seems that the pauci- immune diseases have more widespread systemic involvement than Goodpasture's. Hope that helps!
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Old 09-13-2010
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Ohhh - Pauci Immune is a group of diseases? Not a separate disease... Thanks for clarifying that - phew - one less thing to memorize..

So Churg strauss / Wegeners / Microscopic polyangitis are all ANCA positive vasculitis

Thanks for your help guys!
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