00:01
Now, we're going to our next glomerulonephritis, and this one is an interesting one.
00:06
This is called DPGN.
00:08
The reason I called this interesting is for two main reasons.
00:10
Number one, it’s a fact that really,
in terms of your presentation, it will be nephritic, nephrotic, nephritic, nephrotic.
00:18
And by that I mean, oh, well,
there might be hematuria and RBC casts that are involved in hypertension.
00:23
But there might be actual protein loss of being greater than 3.5 grams of protein.
00:28
There might be lipid that is then risen. Interesting.
00:31
So I just gave you the symptoms in this patient
that has components of both nephritic and nephrotic.
00:37
DPGN will do that.
00:39
Also, the second important point, is that this is the prototype.
00:43
This is the most common subtype of SLE induced kidney damage.
00:48
Now, the other types can have a nephrotic presentation
but what you're keeping in mind is if your patient has SLE
and comes back to be positive for anti-double stranded DNA,
the most likely type of kidney damage or glomerulonephritis
that you're finding in this patient is going to be DPGN.
01:06
Now, what you have to memorize is DPGN, will be sub-endothelial.
01:13
Earlier with P, PSGN, it was sub-epithelial.
01:19
With DPGN, it’s sub-endothelial. Are we clear?
Now, I don’t care how you do it, you memorize that.
01:28
This immune-complex that’s being deposited, where are you?
On the side of the blood and the capillary lumen
or are you on the side of your urine and your podocyte?
Sub-endothelial, will be underneath your endothelial cell in the capillary lumen
between the endothelial cell and the basement membrane.
01:46
With that said, if you find such a deposition, on electron microscopy,
what are you going to find in immunofluorescence?
You tell me the description. Very good. It's a granular.
01:56
Next, if you find this to be SLE induced then, what is this called?
A DNA, anti-DNA immunocomplexes or in other words, Anti-double stranded DNA.
02:07
You're also going to find activation of your complement pathway
but any immune-complex will do that.
02:13
Now, what you do find, and the description is called wire looping of the capillaries
corresponding to sub-endothelial immune-complex.
02:21
There’s going to be neutrophil infiltration with hyaline thrombi in the capillary lumen.
02:26
There’s enough information here for you to properly diagnose your patient with DPGN.
02:30
Look for SLE and look for anti-double stranded DNA,
and the fact that you have sub-endothelial deposits giving you a granular pattern.
02:38
Next, kidneys are major target organ in SLE for DPGN.
02:44
Your serum ANA test usually has a rim pattern
which then corresponds with, please take a look, anti-double stranded DNA.
02:54
How many kidneys do you have? Two. Double stranded.
02:57
If it’s SLE in antihistone, it’s drug induced SLE, isn't it?
And by drug-induced, you might be thinking about, well, procainamide.
03:07
You might be thinking about hydralazine, isoniazid,
and for different reasons, maybe phenytoin.
03:14
Evolves into chronic renal failure in most cases.
03:18
And ends up being a common cause of death
in a patient with SLE is actually chronic renal failure.
03:26
An important point.
03:28
Please make sure that you're quite familiar with the SLE induced DPGN issue
resulting to chronic renal failure with the various tests that we just walked through.