Diffuse Proliferative Glomerulonephritis (DPGN) | Lupus Nephritis | Nephrology | 5-Minute Review.

hello lovely people this is mitochosis perfectionators where medicine makes perfect sense let's continue our five-minute review playlist in the last videos we talked about membranous nephropathy diabetic nephropathy and amyloid nephropathy today it's time to discuss diffuse proliferative glomerulonephritis if it ends in itis it's inephritic syndrome this disease is nephritic and nephrotic in the same time if it's nephrotic you're gonna lose a protein in the urine if it's nephritic you're gonna lose blood in the urine and in this disease you lose both proteins and blood in the urine when the patient has diffuse proliferative glomerulonephritis you can bet the rent money the patient has lupus this is my five minute review playlist please watch these videos in order if you just want to watch the kidney ones there is a playlist called nephrology especially the ones about kidney disease such as nephrotic syndrome minimal exchange disease focal segmental glomerular sclerosis membranous diabetic amyloid nephropathy etc diffuse proliferative glomerulonephritis is nephrotic and nephritic if it's nephrotic you're losing protein in the urine and you can get edema normal kidney is like a normal colander but nephrotic kidneys like a bad condor it lets protein through you're losing protein in the urine when you lose protein in the urine you lose your oncotic pressure hashtag edema when i have nephrotic syndrome there will be high protein in my urea low protein in my emia edema and hyperlipidemia when i have nephritic itis means inflammation oh the kidney is inflamed what's going to happen blood in the urine high blood pressure hematuria and hypertension don't forget these in the next videos we will add more symptoms to the nephritic syndrome but the moral of the story is if your patient has diffuse proliferative glomerular fries it means number one they have lupus number two they have nephrotic and nephritic so they are losing protein and blood in the urine let's review what we have discussed before nephrotic syndrome minimal change disease focal segmental glomerulous sclerosis membranous nephropathy diabetic nephropathy amyloid nephropathy today we're talking about this doofus right here diffuse proliferative glomerular arthritis which includes nephrotic and nephritic in the same patient at the same time when i say focal it means only few glomeruli when i see diffuse almost all of the glomeruli are affected when i say segmental only a segment of the nephron is affected but what about proliferative proliferative means that the glomerus is getting hyper cellular so when i say diffuse proliferative glomerulonephritis it means that basically almost all of your glomerular affected and they are hypercellular they are inflamed that's white enzynitis and you're leaking protein and blood in the urine a good kidney should not filter plasma proteins and should not filter red blood cells but this kidney is screwed it lets protein and blood in the urine this is your normal kidney right here afferent arterial capillary tuft efferent arterial and then let's talk about the layers here you have endothelium and then a basement membrane and then podocyte in diffuse proliferative glomerulonephritis what's happening here what's happening is that this glomerus is inflamed okay that's why we call it itis we also have immune complex deposits were under the endothelium sub-endothelial deposits they destroy your capillary tuft and this will get hyper cellular and crazy it will start looking like this you see that yup we call this wire looping thick inflamed tons of deposition and looks curly like this we call this wire looping sub endothelial deposits of immune complexes diffuse proliferative glomerulonephritis is both nephrotic and nephritic and your patient has lupus this is your lovely basement membrane here you have the epithelium here is the endothelium if i have diffuse proliferative glomerulonephritis i will have immune complex deposition here underneath the endothelium called sub endothelial immune complex deposition how would i see this immune fluorescence under an electron microscope and these deposits will cluster like this and we call it a granular pattern let's talk about lupus very quickly if you want to learn more about lupus i have a video on lupus on my website medicosis perfectionist.com what's the most common visceral organ involved in lupus it's the kidney we call it lupus nephritis there are many criteria to help you diagnose lupus one of them is a kidney disease in lupus we have immune complex deposition in your skin and in your kidney when it comes to your kidney these are sub endothelial deposits right here and they are granular in pattern most patients with lupus have kidney disease what kind of kidney disease well it depends we have six classes it could be very mild like a minimal change disease remember minimal mesangio lupus nephrites or it could be class 2 mesangial proliferative lupus nephritis hypercellularity here it could be focal lupus nephritis or it could be diffuse lupus nephritis which is today's topic what we call diffuse proliferative glomerulonephritis this is the most common and the most severe form of lupus nephritis class 5 is membranous class 6 is advanced sclerosing lupus nephritis say goodbye to your kidney 50 to 70 of lupus patients have kidney disease it could be nephritic it could be nephrotic it could be both for example diffuse proliferative glomerular fluids is nephritic membranous nephropathy is mostly nephrotic a common cause of death is chronic kidney disease which ends up in end stage renal disease when your gfr is very low we talked about minimal changes before remember the patient is young prognosis was excellent remember steroids then we talked about focal segmental the patient is older the disease is more severe usually hiv or heroin or parvo b19 the prognosis is not as good then we compared between the two diseases in previous videos then we talked about membranous where your glomerular basement membrane is super thick spikes and domes this is the most likely nephrotic syndrome to cause renal vein thrombosis dvt pe etc if you have chronic uncontrolled diabetes for more than 10 years you get diabetic nephropathy remember to give ace inhibitors and to manage the diabetes high ln arterial sclerosis claims style wilson nodule amyloid nephropathy could be primary amyloidosis or secondary amyloidosis amyloid deposition congo red apple green birefringence you cannot treat it without treating the underlying disease now it's time to talk about diffuse proliferative glomerulonephritis the patient has lupus diffuse proliferative is the most common and most severe subtype of lupus nephritis it has nephrotic and nephritic the patient is losing protein and blood in the urine blood pressure is usually high immunofluorescence you see granular sub-endothelial immune complexes i also see this on electron microscopy on light microscopy tons of neutrophils itis means inflammation hyaline thrombi and the capillaries are weird and they look like a wire loop eventually this will lead to scarring of the glomeruli say goodbye to your kidney treatment give steroids cyclophosphamide as early as you can these are immunosuppressive because lupus is an autoimmune disease prognosis is horrible eventually will cause rapidly progressive glomerus which can lead to chronic renal failure and staged renal disease rest in peace we're gonna miss you lupus is so horrible i'm not making fun of patients i'm trying to make medicine easy for medical students so that you can help patients end stage renal disease is when your gfr is less than 15 ml per minute normally it should be 125 this is so low pause and review i have close to 1 000 videos on this youtube channel but i have premium courses on my website such as the renal physiology course my website is mitochosisperfectionist.com i also have an acid-base imbalance course and a cardiac pharmacology course and while most students are not studying in january you my friend are the exception so here is a 60 discount for you just use promo code new year learning and this discount applies to any product on my website thank you for watching please subscribe hit the bell and click on the join button you can support me here or here go to my website download my courses be safe stay happy study hard this is mitochosis perfect schneiderless where medicine makes perfect sense