00:01
Thickening at the basement membrane with MPGN,
formation of tram-track either type I or type II, can be primary or secondary.
00:08
Immune complex will be the most common.
00:11
That will be type I as we have discussed.
00:13
CLL, lymphoma, melanoma.
00:16
All of these, once again, associations.
00:18
Clinical features could be nephritic, nephrotic, or mixed.
00:22
Decrease serum C3, much more so with type II.
00:26
Prognosis, slowly progressive course.
00:29
Many of your patients within 10 years will go into chronic renal failure.
00:34
Overall picture of MPGN.
00:36
Where do you begin your biopsy and pattern differentiation?
At the level of electron microscopy.
00:42
Know the flow chart well that I showed you earlier between the two.
00:45
Know the details that we walk through here, with type I and type II.
00:50
Type I, sub-endothelial, striking tram-track.
00:54
Type II, dense deposit disease.
00:57
Nephritic factor, what does it do?
It then causes stabilization and deposition, less striking tram-track but both will have it.
01:06
Clinically characterized by, decrease levels of C3, type II complement mediated damage.
01:14
On your upper left in the cartoon, type I sub-endothelial, type II intramembranous.
01:22
That intra membranous, upon electron microscopy,
will then show you dense deposit disease.
01:27
The one on your left represents sub-endothelial.
01:33
Let’s do the pattern organization.
01:35
I don’t wanna get away from that.
01:36
Number one, find the pave road. Where is it?
You see that light gray paved road in the membrane?
That’s your glomerular basement membrane.
01:49
I would like for you to find feet.
01:52
The feet are on top, that’s your foot processes.
01:57
So that’s the urinary side, upper right.
02:00
Lower side, you’ll find that huge, dark, density?
That’s your sub-endothelial deposit, type I.
02:08
You see that membrane? Yeah, Dr. Raj.
02:12
But that looks awfully dark to me?
That’s the pathology. Clear?
That’s dense deposit disease. That’s type II.
02:19
Where’s the CL? That would be capillary lumen. But who cares?
The reason I say that
is because it’s deposition of dense amorphous material in your membrane.
02:27
Welcome to type II.
02:30
Can you give me the pathogenesis here. Nephritic factor.
02:34
What does that do? Destroy or stabilize C3 convertase.
02:39
Do you remember? Do you hear my terminology?
It stabilizes C3 convertase. Good. Intense.
02:45
But you have to know at least that much to get your questions right.