Now, we're going to our next glomerulonephritis, and this one is an interesting one.
This is called DPGN.
The reason I called this interesting is for two main reasons.
Number one, it’s a fact that really,
in terms of your presentation, it will be nephritic, nephrotic, nephritic, nephrotic.
And by that I mean, oh, well,
there might be hematuria and RBC casts that are involved in hypertension.
But there might be actual protein loss of being greater than 3.5 grams of protein.
There might be lipid that is then risen. Interesting.
So I just gave you the symptoms in this patient
that has components of both nephritic and nephrotic.
DPGN will do that.
Also, the second important point, is that this is the prototype.
This is the most common subtype of SLE induced kidney damage.
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.
Now, what you have to memorize is DPGN, will be sub-endothelial.
Earlier with P, PSGN, it was sub-epithelial.
With DPGN, it’s sub-endothelial. Are we clear?
Now, I don’t care how you do it, you memorize that.
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.
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.
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.
You're also going to find activation of your complement pathway
but any immune-complex will do that.
Now, what you do find, and the description is called wire looping of the capillaries
corresponding to sub-endothelial immune-complex.
There’s going to be neutrophil infiltration with hyaline thrombi in the capillary lumen.
There’s enough information here for you to properly diagnose your patient with DPGN.
Look for SLE and look for anti-double stranded DNA,
and the fact that you have sub-endothelial deposits giving you a granular pattern.
Next, kidneys are major target organ in SLE for DPGN.
Your serum ANA test usually has a rim pattern
which then corresponds with, please take a look, anti-double stranded DNA.
How many kidneys do you have? Two. Double stranded.
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.
You might be thinking about hydralazine, isoniazid,
and for different reasons, maybe phenytoin.
Evolves into chronic renal failure in most cases.
And ends up being a common cause of death
in a patient with SLE is actually chronic renal failure.
An important point.
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.