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→Autopsy Findings
== Clinical Summary == During the course of a routine physical examination two months prior to admission, this 57This 27-year-old white male was noted to have a lesion in had end-stage renal disease requiring hemodialysis for 10 years. For the upper lobe of the right lung. Initially, previous four years he was treated for two weeks with ampicillin. He was then admitted had hypertension which slowly increased to an outside hospital for further studyabout 180/120 mm Hg. All studies including sputum studies for tubercle bacilli, bronchial washings, Laboratory findings included a markedly elevated BUN and bronchoscopy were negative creatinine. He underwent bilateral nephrectomy and he was discharged. Review of systems revealed the presence of mild dyspnea placed on exertion, accompanied by a slightly productive cough. Of interest was the fact that the patient had been PPD positive for the past 4 to 5 years, but this had never been evaluated. On this hospital admission, physical and laboratory examinations were negative. Radiographic examination of the chest revealed a 2 x 2-cm density in the right lower lung field. Several small cavities were identified in this area on CT scantransplant list.
== Images ==
File:IPLab6GN10.jpg|For comparison this is an immunofluorescent photomicrograph of a glomerulus from a patient with Goodpasture's syndrome. The linear (arrows) immunofluorescence is characteristic of Goodpasture's syndrome.
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== Virtual Microscopy ==
<peir-vm>IPLab6GN</peir-vm>
== Study Questions ==
* <spoiler text="What is the usual clinical course of poststreptococcal glomerulonephritis?">One to two weeks after infection (usually sore throat or skin infection) by certain types of group A beta-hemolytic streptococci, patients develop malaise, fever, nausea, oliguria, and hematuria. Most patients recover with conservative treatment aimed at maintaining sodium and water balance. The renal injury usually resolves with no loss of function.</spoiler>
* <spoiler text="What is the pathogenetic mechanism of poststreptococcal glomerulonephritis?">Patients have elevated antibody titers to streptococcal antigens, decreased complement levels, and accumulations of immune complexes and complement in the glomeruli suggesting immune complex mediated glomerular injury. Some streptococcal antigens (endostreptosin and several cationic antigens) have been demonstrated on the glomerular basement membrane. Thus, it is not known for sure if the glomerular damage is caused by circulating antigen antibody complexes, antibodies attacking streptococcal antigens that are attached to the basement membrane, or a combination of both processes. In any event, antibodies bind to antigens, activate complement, and cause damage to the glomeruli.
</spoiler>
== Additional Resources ==
=== Reference ===
* [http://emedicine.medscape.com/article/429314-overview eMedicine Medical Library: Assessment and Management of the Renal Transplant Patient]
* [http://emedicine.medscape.com/article/240337-overview eMedicine Medical Library: Poststreptococcal Glomerulonephritis]
* [http://www.merckmanuals.com/professional/genitourinary_disorders/glomerular_disorders/nephritic_syndrome.html Merck Manual: Nephritic Syndrome]
* [http://www.merckmanuals.com/professional/genitourinary_disorders/chronic_kidney_disease/chronic_kidney_disease.html Merck Manual: Chronic Kidney Disease]
* [http://www.merckmanuals.com/professional/genitourinary_disorders/renal_replacement_therapy/hemodialysis.html Merck Manual: Hemodialysis]
* [http://www.merckmanuals.com/professional/immunology_allergic_disorders/transplantation/kidney_transplantation.html Merck Manual: Kidney Transplantation]
=== Journal Articles ===
* Lan HY, Yang N, Nikolic-Paterson DJ, Yu XQ, Mu W, Isbel NM, Metz CN, Bucala R, Atkins RC. [http://www.ncbi.nlm.nih.gov/pubmed/10652026 Expression of macrophage migration inhibitory factor in human glomerulonephritis]. ''Kidney Int'' 2000 Feb;57(2):499-509.
=== Images ===
* [{{SERVER}}/library/index.php?/tags/226-glomerulonephritis PEIR Digital Library: Glomerulonephritis Images]
* [http://library.med.utah.edu/WebPath/RENAHTML/RENALIDX.html#8 WebPath: Glomerulonephritis]
== Related IPLab Cases ==
* [[IPLab:Lab 1:Kidney Infarction|Lab 1: Kidney: Infarction (Coagulative Necrosis)]]
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[[Category: IPLab:Lab 6]]