this video is nephritic versus nephrotic syndromes and this is brought to you by dirty medicine if you like what i'm doing here on this channel and you want to give back and support the channel financially then please click the join button you'll see this join button shown here on this slide circled in red which is on my channel home page it's on the bottom of every single video and it's also a link in the description of every single video on my channel when you click the join button you sign up to become a dirty medicine member what that means is that in exchange for paying 4.99 a month you get access to some really cool perks the first is that you'll be able to vote on my community page of my channel so there's going to be members only voting where you can have your vote cast to help determine the topic of my next video in addition anytime you comment anywhere on my channel you'll get the little dirty medicine logo next to your name so everybody who sees your comment will know publicly that you're a dirty medicine member which means you're somebody that wants to give back and support my mission to provide free quality medical education so if you like dirty medicine you like what i'm doing here on my channel you're looking for a way to give back and support this free resource please consider clicking that join button now in today's video we're going to be talking about nephritic versus nephrotic syndromes and i want to start by kind of creating this conceptualization of these diseases so that you can keep them straight in your head because for whatever reason medical students get super super overwhelmed when it comes to all the nephritic and all the nephrotic syndromes i think that's probably because they share a lot of overlapping features there's a lot of associations there's a lot of buzzwords you have to know what the images look like there's just generally speaking a ton of information that's fair game and high yield for usmle and comlex so i want to start by creating this concept of what we're talking about and how we differentiate nephritic versus nephrotic syndrome now to be clear nephritic and nephrotic syndrome can both be considered glomerular disease okay and the question becomes is how much protein is in the urine or how what's the degree of proteinuria so if there's more than three and a half grams of protein per day in the urine that's nephrotic syndrome so we're talking about the left side of this flow chart but if by contrast there's less than 3.5 grams per day of protein that's going to be nephritic syndrome and that's going to be on the right side of this flow chart now to be clear there is an overlapping syndrome where you can technically have a mixed nephritic nephrotic syndrome with signs and symptoms of nephritis or kidney inflammation but with nephrotic range proteinuria so this isn't as cut and dry or as black and white as i'm making it out to be but i think the key to being able to understand what's the difference between nephritic and nephrotic syndrome really comes down to this conceptual conceptualization of proteinuria so the the takeaway so far is that nephrotic syndrome has lots of protein in the urine and that's easy to remember if you just memorize nephrotic syndrome prot for protein so neprotic syndrome or nephrotic syndrome is the one with lots of proteinuria and to be exact more than three and a half grams per day now what are the symptoms of nephrotic syndrome and what are the symptoms of nephritic syndrome i'm gonna put them on the slide now so let's let's start with nephrotic syndrome so in nephrotic syndrome you see hypoalbuminemia right you can think about this as since all of that protein is coming out in the urine you're losing albumin so you're gonna have hypoalbuminemia you're also going to have hyper lipidemia and i can't take credit for this but if you refer to pathoma dr sitar has an excellent explanation of thinking about the liver putting out all of this extra stuff to compensate for the fact that all of this loss is in the urine coming out and you're just you know you're losing albumin you're losing your gamma globulins and therefore the liver is really overproducing some substances and that explains why you get hyperlipidemia hypogamma globulinemia again you're losing those in the urine and hyper coagulability because of the clotting factors and the liver so you can think of the liver as compensating for the kidney which is just peeing out and losing all of these substances in the urine because we're talking about neprotic aka nephrotic syndrome all right so you think about the pathophysiology here you have some type of damage to the to the kidney and therefore you're urinating out all of these substances so you have hypo albuminemia hypo gamma globulinemia losing them in the urine and then the liver trying to compensate by putting more into the serum is going to lead to hyper lipidemia and hyper coagulability all right so those are the main symptoms of nephrotic syndrome and they're very important to understand because on a test question on usmle or comlex sometimes they'll just give you the little chart with the lab values and you have to see that oh there's decreased albumin oh there's decreased gamma globulins oh there's hypercoagulability so you have to be able to recognize that work backwards and infer that you're dealing with a nephrotic syndrome all right now let's talk about nephritic syndrome now so technically anytime you see idic or itis it means inflammation so nephritic or nephritis would be inflammation of the kidney now due to this inflammation the kidney is unable to perform some of its key functions namely regulating blood pressure so you see the symptom of hypertension regulating the proper excretion of fluid or the proper filtration of fluid so you see edema you'll get hematuria because you have damage and inflammation of the kidney itself you'll see these things called acanthocytes and i've put an image of acanthocytes on this slide you might see the picture just the picture of the cell itself and have to associate these cells with nephritic syndromes or you could just get the description in the test question which would say thorn-like cytoplasmic projections in either event your brain should be firing and saying oh this might be in a canthocyte and therefore i should be thinking about the nephritic syndromes you'll also see oleguria which means decreased urinary output and azotemia which means increased bun and increased creatinine these are all signs and symptoms of inflammation of the kidney which is nephritis remember that itis means inflammation so now that we've talked about the differences in the symptoms between the neprotic increased protein being lost in the urine and the nephritic itis meaning inflammation of the kidney let's talk about the different diseases that you need to know for us mle and comlex now again i want to preface all of this by saying there is certainly a gray area here where you get overlapping nephritic nephrotic mixed syndromes but for the purposes of memorizing and understanding these diseases it's really important that you separate them so for the nephrotic syndromes we have five diseases that you need to know one focal segmental glomerulous sclerosis two minimal change disease three membranous nephropathy four diabetic glomerulonephropathy and five amyloidosis for nephritic syndrome we also have five that you need to know one post-streptococcal glomerulonephritis two rapidly progressive glomerular nephritis three iga nephropathy four alport syndrome and five membrano proliferative glomerulonephritis now if you think about the names of these five diseases you'll notice that three of them end with nephritis which should help your brain and cue your brain to memorize and understand that those diseases are obviously nephritic syndromes because they end in nephritis now i want to just take a moment and explain something that should be somewhat obvious but will really help solidify the basis of this information and the question is why do you get proteinuria in the nephrotic syndromes and also in the mixed overlap nephritic nephrotic syndromes if you think back to your physiology when you learned about the kidney in medical school recall that you have this basement membrane which is shown here on my slide in light blue below the basement membrane you have the endothelium there's a lot of different specialized endothelial cells but just generally speaking we refer to this as the endothelium and then on the top in this green color you've got the podocytes the foot processes the podocytes or the foot podocytes you'll see all of those terms used interchangeably but it's the collective image that you see here the combination of the basement membrane plus its supportive endothelium plus its specialized foot podocytes that together help the kidney filter or hyperfilter the blood into the filtrate and recall that you're passing the fluid from the blood through to the filtrate so if any one of these three items the endothelium the basement membrane or the podocytes get damaged you're not going to be able to appropriately filter in the kidney and it's because of this in nephrotic syndrome that you get proteinuria so as you'll see as we move through the different nephrotic syndromes you're going to have things like effacement of foot podocytes or damage or swelling of the basement membrane or disruption of the endothelium the point i'm making here is that it doesn't matter what the pathophysiology is but if you affect any one of these three substances you can't appropriately hyper filter in the kidney and therefore it should make sense to you that protein and other substances will be spilling out into the urine because you're disrupting this system so if you think back to all of the stuff that you've learned in medical school maybe you've been going through pathoma or other resources you kind of know your buzzwords you know there's disruption of basement membrane you know there's a faceman of foot processes and i hope it's starting to click in your brain that when you have those buzzwords that's the reason you get proteinuria it's not like the kidney is just you know creating proteinuria for no good reason think fundamentally about the pathophysiology and this should make a lot more sense to you so now let's get started by going through these diseases one at a time we're going to go through the nephrotic syndromes first since they just explained the basis of the protein oreo so let's start with focal segmental glomerulosclerosis now the way that this will work is i i really want you guys to just have the high yield takeaways here and in all of these diseases the main high yield information that shows up time and time again on usmle and comlex is what are the associations what do the images look like and what are the buzzwords that describe those images so that's how we're going to approach this so for focal segmental glomerulosclerosis this is the most common nephrotic syndrome in african american and hispanic populations this is also highly associated with sickle cell disease and hiv so you want to know these four associations african americans hispanics sickle cell patients and hiv patients as far as the high yield images and the descriptions this is what you're going to see so i've put two images here for you you could see them described as hyalinosis and segmental sclerosis you're definitely going to see effacement of foot podocytes which again going back to our discussion from just a few moments ago should really explain why you're spilling protein because the foot protocytes are damaged you also may see a description of non-specific igm c1 or c3 deposition in a mesangial matrix so any one of these three descriptions is describing the same disease process these images you need to be able to recognize them so this is focal segmental glomerulosclerosis and these are your images and these are your descriptions so that's our first nephrotic syndrome again know your associations african americans hispanics sickle cell and hiv know that you're going to see a faceman of foot podocytes know these other secondary descriptions and be able to pick this up by looking at the image now let's talk about the next nephrotic syndrome minimal change disease this happens to be the most common nephrotic syndrome in children sometimes this is associated with having a recent infection or immunization status and rarely this can be associated with hodgkin lymphoma now the interesting thing about minimal change disease and focal segmental which we just talked about is that both of these nephronic syndromes have effacement or damage to the foot podocytes so that in and of itself will not point you in the direction and sometimes on tests especially on usmle or complex if we're talking about step in level two where you're expected to know more epidemiology you should probably make the guess as to which disease it is depending on if it's a child think minimal change disease or if it's an adult think fsg but here are the images for minimal change disease you might see descriptions such as negative immunofluorescence because you're not really going to see anything on immunofluorescence the effacement of the foot podocytes but also the fusion of them so keep that buzzword in mind as well and the glomeruli here are going to appear normal so the normal appearing glomeruli and the negative immunofluorescence is what really is going to separate minimal change from fsg in addition to the fact that if it's a child patient it's pretty likely to be minimal change disease now how do you remember this well my mnemonic is that children are of minimal age and tend to have small feet children tells us that we're talking about the nephrotic syndrome most common in children minimal for minimal change disease and having small feet reminds me of the effacement or the fusion of the foot process or the foot podocyte so you want to just memorize this sentence children are of minimal age and tend to have small feet that'll tell you we're talking about minimal change highly highly common in children and tend to have small feet reminds you of a face manifusion of the foot podocytes so that's minimal change disease let's move on to our next nephrotic syndrome membranous nephropathy so there are actually two different types of membranous nephropathy you can have primary membranous nephropathy or secondary membranous nephropathy now primary is due to antibodies against phospholipase a1 so if you're taking usmle or comlex you might see anti-pla2r that is membranous nephropathy and that's the primary cause of it but this can also be secondary to either infection disease or medication so you want to know the association with hepatitis c and hepatitis b autoimmune diseases such as lupus and medications which could include nsaids penicillin or gold now without a doubt the highest yield part of membranous nephropathy are knowing these images and knowing these descriptions so memberness nephropathy has a classic buzzword which is spike and dome appearance the full sentence would be something like spike and dome appearance with sub epithelial deposits and you can see evidence of that on these three images especially on the little one shown in gray you're going to see a thickened basement membrane and thickened capillaries and you want to be able to pick these images up and if you take a close look at these images and compare them to the images from the first two nephrotic syndromes that we talked about you can obviously see a pretty major difference so from membranous nephropathy know the spike and dome appearance with sub-epithelial deposits usually but not always the image that's depicting that spike in dome appearance will be the one that you see in gray so you want to keep that in mind so how do you memorize this right membranous nephropathy so what i say as my one sentence mnemonic here is that i'm a proud member of the spike and dome club amma and the p in proud remind me of eye for infection m for medication a for autoimmune disease and p for phospholipase a1 so i'm a i'm a proud or i'm a p from proud are the four letters that help me memorize the association so membranous nephropathy associated with imap infection medication autoimmunity and phospholipase a1 member just reminds me that this mnemonic goes with membranous nephropathy and europe i'm a proud member of the spike and dome club is my way of memorizing that the very very high yield buzzword and the thing that gets shown with those images are the spike and dome appearance okay so that is the easy one sentence mnemonic to to memorize memberness nephropathy now let's talk about diabetic glomerulonephropathy so this one happens to be the most common cause of end-stage renal disease in high-income countries and in the united states usually if the test writers on u.s emily or comlex want you to go after or want to go after diabetic glomerulonephropathy they'll give you a patient with some evidence of other diabetic complications so you might see patients with retinopathy neuropathy or gastropathy not always but sometimes it's there just to really help sell you on the fact that it's diabetic glomerulonephropathy what's actually really high yield about diabetic glomerulonephropathy there's two things one the pathophysiology is high yield and two the classic image or buzzword is high yield so let's talk about the um the pathophysiology first so what causes diabetic glomerulonephropathy is you get non-enzymatic glycosylation of the vascular basement membrane okay and when that happens when those sugars get glycosylated or covalently linked to other substances it leads to hyaline arteriosclerosis within the kidney which then once you have that hyaline arteriosclerosis causes hyperfiltration more at the efferent than afferent arterial and then you get the subsequent microalbuminuria so protein loss through the urine so it's the sugar being covalently linked to different substances in the kidney which causes one arteriosclerosis then two hyperfiltration which leads to three microalbumin oreo so this is why if you're on the wards if you're in the hospital as a third or fourth year medical student you'll see that one of the tests that we do for patients with diabetes and evidence of diabetic complications is to check their urine for microalbumin because that would be suggestive of this complication of this diabetic glomerulonephropathy which is due to the fact that they've got such high blood sugars all the time so they're non-enzymatically glycosylating the vascular basement membrane in their kidney so as far as nephrotic syndromes go you need to understand that pathophys but what you probably should take away if you're only going to learn one thing is this kimmel steel wilson nodule so the image that you see here especially on the left is incredibly high yield these are kimmel steel wilson nodules and they're classically associated with diabetic glomerulonephropathy just for completeness sake you might see mesangio sclerosis or if the test writers are really feeling like bastards on that one day that they write the question instead of writing kimmel still wilson nodule they might describe it so the description of it is a sclerotic eosinophilic nodule with a central acellular region so if you see that you see kimmel still wilson or you see the image especially the one shown on the left they're talking about diabetic glomerulonephropathy now how do you memorize this well i had a really really stupid mnemonic a visual mnemonic actually when i was in medical school and to memorize kimmel still wilson nodule i would i literally put this picture in my notebook i had jimmy kimmel and owen wilson and a and a blood sugar meter so i would just memorize kimmel plus wilson for kimmel still wilson and the the blood sugar monitor reminded me that these two guys next to this blood sugar monitor kimmel still wilson nodules are associated with diabetes so this is my visual mnemonic hopefully it's helpful to you as well the last nephrotic syndrome that we'll talk about before we switch gears and then go on to nephritic is amyloidosis so systemic amyloidosis obviously as you you hopefully know at this point it affects a lot of different organs in the body but it most commonly affects the kidney it can be associated with tuberculosis multiple myeloma rheumatoid arthritis and more what's really really high yield to know about amyloidosis are the two different amyloidosis associated proteins and which diseases they're associated with so there's an a a protein and an al protein and my mnemonic is that a a protein is associated with inflammation so you see the a's in inflammation the aa in a a protein whereas the al protein is associated with multiple myeloma so al protein with the al in multiple myeloma and being able to put those proteins into the context of what diseases they're associated with can score you some extra points on test day now the very very high yield image and buzzword is that for all of the organs affected by amyloidosis you will see apple green birefringence under polarized light so if you see an image that looks kind of greenish like this they're pointing you in the direction of amyloidosis so at this point we've gone through five diseases and they're all nephrotic syndromes for your studying pleasure these are all five of the high-yield nephrotic syndromes again what do you want to take away from this you want to know the associations the buzzwords and the images so for focal segmental glomerulosclerosis african americans hispanics hiv sickle cell minimal change disease in children recent infection immunization hodgkin lymphoma membranous nephropathy hep c hep b lupus and some of your meds diabetic glomerulonephropathy diabetics amyloidosis either chronic inflammation with aa protein or multipal myeloma with al protein and then i put my mnemonics in there on that last column just for your studying pleasure didn't have a good one for fsg but for minimal change disease remember that children are of minimal age and tend to have small feet for membranous nephropathy i'm a proud member of the spike and dome club for diabetic glomerulonephropathy my visual mnemonic of jimmy kimmel owen wilson and a diabetic meter and lastly for amyloidosis just remember the aa protein for chronic inflammation and the al protein for multiple myeloma so those are all of the different nephrotic syndromes or nephrotic diseases now let's switch gears and look at everything in blue on the flow chart all of the nephritic syndromes and in doing so we will get started with poststreptococcal glomerulonephritis so psg usually occurs in children and it occurs somewhere around two to four weeks after infection or exposure to group a beta-hemolytic strap so sometimes the test writers will be super cool and they'll they'll tell you that it was group a beta hemolytic strap other times they'll just describe the symptoms that the patient had and you'll kind of have to work backwards in your brain and infer oh this is probably a group a beta hemolytic strep infection now from that you get this type three hypersensitivity reaction which is post streptococcal glomerulonephritis and if they give you some labs or they give you some buzzwords you're gonna see anti-streptococcal antibodies so a positive aso and decreased serum c3 levels now how do you remember all this information because admittedly this is all pretty important for usmle and comlex my mnemonic is when i think of psg i think ps3 and the three in ps3 tells you a lot of really important information one this is a type 3 hypersensitivity reaction two this occurs roughly three weeks after infection aso has three letters and there's a decrease of serum c3 so if you can remember ps3 the three tells you everything that you need to know now as far as the image goes the way that this could be described is enlarged hypercellular glomeruli or what i think you'll probably see most likely is lumpy bumpy or granular or a starry sky appearance especially in immunofluorescence or if they give you the em image which you see all the way to the right on the slide they might describe that also as sub epithelial humps but really the highest yield buzzword is lumpy bumpy and if you look at the center image on this slide you see that on the immunofluorescent stain it's not a smooth linear deposition like you might see in some of the other nephritic diseases by contrast it's lumpy bumpy it's sort of granular and it has that sub-epithelial alternating humping to it and if we just go back to our mnemonic here i could really add one more thing to to to really hammer this in is that we can add lump three bump three so instead of saying you know lumpy bumpy we just change that to lump three bump three which should remind you that psg equals ps3 three lump three bump three so if you see lumpy bumpy you have to know that it's associated with psg okay so that's our first nephritic disease now let's go to rapidly progressive glomerulonephritis rapidly progressive glomerulonephritis as the name would suggest just refers to rapid progression of kidney disease so there's some type of nephritis some type of inflammatory kidney disease and it rapidly progresses so it takes days to weeks before the patient can really reach kidney failure now the term rapidly progressive glomerulonephritis is actually an umbrella term that is comprised of various individual diseases and we determine which of those diseases or which subtype of rapidly progressive glomerulonephritis we have based on immunofluorescence so the four different diseases that fall within this umbrella of rapidly progressive glomerulonephritis include good pasture syndrome granulomatosis with polyangiitis or formerly known as wegeners microscopic polyangiitis and diffuse proliferative glomerulonephritis now the way that you could tie these together is option one is you pick the individual subtype disease so for example good pasture or microscopic polyangiitis based on buzzwords that you already know and already studied so you probably know a little bit about granulomatosis with polyangiitis and therefore if you got a question on it you could probably identify that that's the disease in question based on some of the buzzwords which your brain already associates with granulomatosis with polyangiitis but what you need to train your brain to do here is not only understand oh you know they mentioned the positive anchor so i know that it's granulomatosis with polyangiitis but take that one step further and know that granulomatosis with polyangiitis is a type of rapidly progressive glomerulonephritis okay so the the the fact that those diseases fall within rapidly progressive glomerulonephritis is very important now as far as getting the individual diseases go your i told you option one was to just get the disease based on the association that you already know option two is to use the immunofluorescence pattern to figure out which disease they're talking about so good pasture syndrome is going to have linear immunofluorescence staining both granulomatosis with polyangiitis and microscopic polyangiitis are considered negative or policy immune which means that there's weak or absent staining so you're either not going to see staining or it's going to be very very weak and then diffuse proliferative glomerulonephritis is granular so options there's three linear granular or negative slash policy policy is just a prefix which means weak or absent or few okay now before we go to each of these four different subtypes as a whole any rapidly progressive glomerulonephritis will have crescents the way that you might see this described is fibrin or macrophage based crescentic expansion because these crescents are made up of fibrin and macrophages or the test writers could be super awesome and just say crescents in bowman space and if you see crescents you need to think rapidly progressive glomerular nephritis and you also want to think on one level deeper and then start to ask yourself are they going for a specific subtype of rapidly progressive glomerulonephritis now you you absolutely need to know the crescents so instead of saying rapidly progressive glomerulonephritis i have always memorized this as rapidly chrysanthemum nephritis so that's my stupid mnemonic but it works wonders because the crescent is the highest yield part of rapidly progressive glomerulonephritis now let's go back to our overview slide so i told you we've got these four subtypes of diseases and i just want to kind of fly through them one at a time point out the or summarize if you will the high yield information that you should already know if you've gone through these in other sections outside of the renal section so first we have good pasture syndrome this is a type 2 hypersensitivity reaction it's marked by anti-glomerular basement membrane and anti-alveolar antibodies and because of that that's where your symptoms come from so you've got pathology in the kidney and pathology in the alveoli so your symptoms unsurprisingly are going to be things like hematuria and hemoptysis now the type 2 hypersensitivity reaction affects type 4 collagen and there's type 4 collagen in the glomerular basement membrane as well as in the alveoli so that's why you have those symptoms now good pasture syndrome as you see in this image has linear deposition and linear staining in its immunofluorescence and if you compare that to the lumpy bumpy that we talked about a few slides prior you can really appreciate the difference so linear looks nice and smooth and lumpy bumpy just looks like little blotches everywhere so be able to differentiate that because if you see the linear the linearity you can compare that against things like weak or absent staining and granular staining now let's talk about granulomatosis with polyangiitis so this was formerly known as wegner's granulomatosis but the name has since been changed this is a small and medium-sized ves vasculitis it's it's positive for pr3 anchor c anka so if you see that that's the biggest buzzword that will point you in the direction of this disease process the symptoms include renal symptoms so things like hematuria lung symptoms things like hemoptysis and nasal symptoms things like chronic rhino sinusitis now i can't take credit for this mnemonic but dr sitar in pathoma drew a giant letter c which crossed through the nose the lungs and the kidney and when you think about that giant letter c he drew that c for wechner granulomatosis the k sound in wechner and that c just touched all the different areas where you would expect to find symptoms now because the name has been changed from wegner to granulomatosis with polyangiitis you could just as easily draw a big letter g which would go through the nose the lungs and the kidneys and the mnemonic would be the same so credit to dr satar for an awesome way to remember the symptoms now i put on this slide a big gray box with palsy equals few and that's just to remind you that there's there's not really going to be an immunofluorescence staining because it's weaker absent staining so i would be surprised if the test writer gives you an image because the image will be pretty weak there's not going to be a lot of staining there so it's going to be a dark image so just know that again granulomatosis with polyangiitis and the disease that we'll talk about on the next slide have weaker absence staining and therefore if they're if you're answering a question about rapidly progressive glomerulonephritis but you don't have any staining or they tell you explicitly that there's weaker absent staining think about this microscopic polyangiitis is a small vessel necrotizing vasculitis it has very similar symptoms to wagners but there's no nasopharyngeal involvement and no granuloma formation it's positive for p anka mpo anka so that's the biggest buzzword for this one that would point you in the direction of microscopic and just like granulomatosis with polyangiitis there's posse posse immune staining so you know weaker absent staining not gonna likely see an image now let's wrap up by talking about diffuse proliferative glomerulonephritis so this is the last type of rapidly progressive glomerulonephritis this one is associated with lupus and it features thickening of the glomerular capillaries which is described as wire loop lesions so if you see wire loops or wire looping or wire loop lesions the answer is diffuse proliferative glomerulonephritis this features granular immunofluorescence which again sort of looks like the lumpy bumpy which you see on the left side of this image but you see those wire loop lesions on the right so you need to memorize wire loop it's the most important part of diffuse proliferative glomerulonephritis and the way that i remember this is instead of saying diffuse proliferative glomerulonephritis i say deflupus and deflupus tells me two things one this is associated with lupus and loop because of wire loop lesions so diflupus proliferative glomerulonephritis is a subtype of rapidly progressive glomerulonephritis so if we put all of our mnemonics together here we would say that deflupus is a subtype of rapidly crescentic glomerulonephritis so on a test if you see the the wire loops or you see the crescents your brain should be spinning using my mnemonics and saying i know that i'm dealing with diffuse proliferative glomerulonephritis and i know that that's a subtype of rapidly chroscentic glomerulonephritis so you see the loops you see the crescents you know where you are mentally so those are the four different subtypes of rapidly progressive glomerulonephritis medical students really get confused because a lot of people don't quite understand that those four can all have crescents and that those four are all rapidly progressive so keep it straight in your head use the mnemonics use the buzzwords and you'll be just fine so now we're going to talk about another nephritic disease but just to be clear we're no longer talking about rapidly progressive glomerulonephritis now we're going to switch gears and talk about iga nephropathy so this is also known as burger disease and the way that you could conceptualize this is this is like the renal manifestation of iga vasculitis so what will you see you'll see normal c3 levels but you'll see increased serum iga levels which isn't terribly difficult to memorize considering the name of this disease is iga nephropathy now the symptoms are pretty important you're going to see asymptomatic microhematuria and you'll see that following either a gi or respiratory infection so on the test if they describe this to you and it doesn't really sound convincing for any one of the different nephritic syndromes but somewhere in the vignette they told you that let's say three weeks ago the patient had x y and z symptoms and their gi or respiratory symptoms now your brain should be running and saying oh i think i'm dealing with iga nephropathy as far as the image is concerned this is what it's going to look like and they'll describe this as one of two different ways one mesangial iga deposition which would be super cool because you know when you see iga you're dealing with iga nephropathy but two they could simply say mesangial proliferation and you need to infer that that mesangial proliferation comes from the damage done by iga deposition so that's iga nephropathy no major mnemonic here because iga is very specific to this nephritic syndrome let's talk about alport syndrome so alport syndrome features glomerular splitting and glomerular thinning and that's both due to a defect in type 4 collagen now this will lead to some symptoms you'll have some sensory neural deafness you'll obviously have glomerulonephritis because we're talking about nephritic syndromes and you'll have lens dislocation retinopathy so we've got hearing problems kidney problems and eye problems so my mnemonic here is can't see can't pee can't hear thee so you can't see can't pee can hear thee though that's the demonic for alport syndrome now as far as the image goes what you want to be able to recognize is what's known as basket weaving basket weaving and this is alternating thinning and thickening of the glomerular basement membrane due to that defect in the collagen so if you see the buzzword basket weaving you have to think alport syndrome it's a very very very high yield buzzword kind of like wire loops kind of like crescents this is the one that goes with alport syndrome our last nephritic syndrome today is membranoproliferative glomerulonephritis also known as mpg mpg is associated with hep c and hep b this is the most likely nephritic syndrome that will co-exist with the nephrotic syndrome and this can be really confusing for medical students because if they give you buzz words and features of mpg but they give you a lab print out and show you excessive proteinuria it's pretty confusing to conceptualize in your brain because your brain's like well there's protein in the urine so it's nephrotic but i think it's mpg so it should be nephritic and this is one of those diseases if you kind of think back to the beginning of this talk today i told you there's overlapping nephritic nephrotic syndromes this is the one that's most likely to do that so there are two types of mpg type 1 and type 2. type 1 mpg is immunoglobulin mediated and that's just super easy to remember because type 1 and the 1 looks like the i in immunoglobulin type 2 mpg is complement mediated so both of these types just to be clear are associated with hep c and hep b but type 1 specifically is associated with lupus and type 2 specifically is actually associated with igg antibodies specifically these igg antibodies stabilize c3 convertase and that process as a whole type 2 mpg is known as dense deposit disease but again both type 1 and type 2 are associated with hep c and hep b both type 1 and type 2 have decreased c3 complement levels and they're both associated with intravenous drug abuse so you want to know those associations especially intravenous drug abuse because if they either tell you that the patient has a history of iv drug abuse or they give you features suggestive of a history of iv drug abuse your brain's got to start running and thinking i'm probably dealing with mpg now the way that this will look is you're going to see tram tracking tram track is the very very high yield buzzword associated with mpg so they might say something like a tram track appearance of the glomerular basement membrane they could say thickening and splitting of the glomerular basement membrane or they could describe it as mesangial ingrowth with a glomerular double contour and if you look at this image the glomerular basement membrane kind of takes on that double contour those two parallel lines and that's described as a tram track so my mnemonic to remember all of this very important information is i get two mpg on the tram track all right so we're talking about mpg to remind us of membrano proliferative glomerulonephritis and mpg at least in the states we refer to that we know that as miles per gallon so it's kind of describing how much fuel economy you get when you're driving so i get two mpg on the tram track tram track obviously because we're talking about the tram track buzzword but track also could remind you of track marks on somebody's arm who might be using engaging in intravenous drug abuse and then two for i get two mpg on the tram track should remind you that there's two types of member note plural glomerulonephritis so this is a really helpful mnemonic it got me a lot of points back in the day when i used to be a medical student i get two mpg on the tram track all right so i've flown through the nephritic syndromes but if you conceptualize them the way that i'm presenting them to you i don't think they're that challenging you've got five post-strap glomerulonephritis rapidly progressive glomerulonephritis and remember the rpg has those four different subtypes and i've put them in that association box iga nephropathy alport syndrome and membranoproliferative glomerulonephritis so know the associations and then know my stupid mnemonic because and guys look i i know at the end of the day it's stupid a lot of these mnemonics are super easy they're like one short sentence but if you're gonna get free points on usmle or comlex i really don't see why you would take the time to memorize nitty gritty details with no easy to remember mnemonic so it's all in this slide for your studying pleasure but this is the end of the video so we started with nephrotic went through all of those and then transitioned to nephritic went through all of those feel free to come back to the video and look at the summarization tables for both nephrotic and nephritic but this is all you need to know if you're gonna if you're able to recall the mnemonics and the information that i gave you in this video you're probably good for like maybe 85 percent if not 90 of all the information that they could ask you on test day so i hope that this video was useful to you i know that this is one of the worst topics that you have to know for boards but good luck with it drop a comment in the comment section and let me know what you guys think