nephrotic/nephritic syndrome

[ddw2013]

A 43-year-old woman with systemic lupus erythematosus has nephrotic
syndrome. Examination of renal tissue obtained on biopsy shows a diffuse
proliferative glomerulonephritis with electron-dense deposits along the
glomerular basement membrane. lmmunofluorescent studies show granular
deposits of complement along the basement membrane. Which of the
following is the most likely cause of these findings?

A.Antibodies directed against glomerular basement membrane
B.Antibodies directed against viral antigens expressed on endothelial
cells
C.Anti-DNA/DNA immune complex deposition in glomeruli
D.Autoantibodies to podocyte antigens
E.CD8+ T-lymphocijte cytotoxiclityzolil‘virds-infected mesangial cells

The answer is clear: C
But...
The first sentence said this patient has membranous nephropathy but the second sentence said this patient has DPGN. So does this patient have both type of diseases?

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[surgok]

nephritic syndrome can advance to nephrotic syndrome.

 

[Phloston]

Membranous glomerulopathy and diffuse proliferative glomerulonephritis are both characteristic of SLE. It's like COPD being emphysema + chronic bronchitis; long-term smokers will rarely have one only in pure form; they'll have a mix of both.

 

[notbobtrustme]

A 43-year-old woman with systemic lupus erythematosus has nephrotic
syndrome. Examination of renal tissue obtained on biopsy shows a diffuse
proliferative glomerulonephritis with electron-dense deposits along the
glomerular basement membrane. lmmunofluorescent studies show granular
deposits of complement along the basement membrane. Which of the
following is the most likely cause of these findings?

A.Antibodies directed against glomerular basement membrane
B.Antibodies directed against viral antigens expressed on endothelial
cells
C.Anti-DNA/DNA immune complex deposition in glomeruli
D.Autoantibodies to podocyte antigens
E.CD8+ T-lymphocijte cytotoxiclityzolil‘virds-infected mesangial cells

The answer is clear: C
But...
The first sentence said this patient has membranous nephropathy but the second sentence said this patient has DPGN. So does this patient have both type of diseases?

ya, but nothing else really fits. The only other you could argue for is D, but effacement of podocyte processes will lead to a more nephrotic syndrome rather than a nephritic syndrome.

 

[xadmin]

Where does it say this person has "membranous nephropathy"? Are you making stuff up that is not there? Totally clear question to me, even said patient has DPGN. No where does it say this person has membranous nephropathy

 

[ddw2013]

Where does it say this person has "membranous nephropathy"? Are you making stuff up that is not there? Totally clear question to me, even said patient has DPGN. No where does it say this person has membranous nephropathy

The first sentence said she had SLE+nephrotic syndrome. Among nephrotic syndrome, SLE is mostly related to membranous nephropathy. This is the reason why I thought she has membranous nephropathy.

 

[xadmin]

Among nephrotic syndrome, SLE is mostly related to membranous nephropathy.

SLE + Nephrotic = DPGN

 

[Apoplexy__]

SLE + Nephrotic = DPGN

The first sentence said she had SLE+nephrotic syndrome. Among nephrotic syndrome, SLE is mostly related to membranous nephropathy. This is the reason why I thought she has membranous nephropathy.

FA lists DPGN in the list of nephritics, but according to FA: "DPGN can present as nephrotic syndrome and nephritic syndrome concurrently."

The boundaries aren't as delineated as some sources say, so I guess you can't just straight up say:
SLE + nephrotic = Membranous
SLE + nephritic = DPGN
Which is what ddw2013 was saying. I'd just go with the above FA reference + what Phloston said and move on.

 

[Transposony]

SLE:

Nephritic - DPGN (Neutrophil induced injury)

Nephrotic -Membranous Nephropathy ( Cytokine induced injury)

Another term used for Membranous Nephropathy in SLE is Diffuse Membranous Nephropathy.

But in reality there is an overlap as Pholston & kirbymiester pointed out.

I think the focus of this question was if you know that lupus nephritis is associated with anti-ds-DNA antibodies.