339.2 🩺 國考版

339.2.1 高頻考點

339.2.1.1 Nephrotic Pentad

  • Proteinuria > 3.5 g/24h
  • Hypoalbuminemia < 3.5
  • Edema
  • Hyperlipidemia
  • ± Hypercoagulability

339.2.1.2 Nephritic Pentad

  • Hematuria + dysmorphic RBC + RBC casts
  • HTN
  • Edema
  • AKI variable
  • Proteinuria variable

339.2.1.3 Top Causes of Nephrotic Syndrome

  • MCD (children, ~ 80%)
  • FSGS (adults in US most common)
  • MN (older adults, anti-PLA2R)
  • DKD (globally most common)
  • Amyloidosis
  • Hep B → MN, Hep C → MPGN

339.2.1.4 Top Causes of Nephritic Syndrome

  • IgA nephropathy (globally most common)
  • PSGN (strep most common pediatric)
  • Lupus nephritis (Class I-VI ISN/RPS 2003)
  • ANCA-associated (GPA, MPA, EGPA)
  • Anti-GBM (Goodpasture)
  • MPGN / C3G
  • IgA vasculitis (HSP)
  • Cryoglobulinemic (Hep C)

339.2.1.5 RPGN Three Types

  • Type I: Anti-GBM (Goodpasture)
  • Type II: Immune complex (lupus, post-infectious)
  • Type III: Pauci-immune (ANCA-associated)
  • Histology: crescents

339.2.1.6 Important Antibodies + Tests

  • ANA, dsDNA: lupus
  • ANCA (PR3=c-ANCA, MPO=p-ANCA): vasculitis
  • Anti-GBM: Goodpasture
  • Anti-PLA2R: primary MN
  • ASO, anti-DNase B: PSGN
  • C3 low: PSGN, lupus, MPGN, C3G, cryoglobulin
  • Free light chains: myeloma, amyloid

339.2.1.7 Biopsy Indications

  • Adults with nephrotic syndrome (often)
  • Unexplained AKI
  • RPGN
  • Steroid resistance
  • Hematuria with proteinuria

339.2.1.8 Renal Biopsy Approach

  • Light microscopy + immunofluorescence + electron microscopy
  • 1-2% bleeding complication
  • Multi-disciplinary

339.2.1.9 Anticoagulation in Nephrotic

  • High-risk: MN with albumin < 2.0-2.5
  • Prevention of thromboembolism (renal vein, DVT, PE)
  • LMWH or DOAC
  • Continue until proteinuria resolves

339.2.1.10 Vaccinations

  • Pneumococcal (especially nephrotic — encapsulated risk)
  • Flu, COVID, RSV, hep B

339.2.2 易混淆比范

Feature Nephrotic Nephritic
Proteinuria > 3.5 g/24h (heavy) Variable (often sub-nephrotic)
Hematuria Variable Hallmark (dysmorphic + casts)
Albumin Low (< 3.5) Variable
Edema Severe (anasarca) Mild-moderate
HTN Less common Common
AKI Less common Common
Hyperlipidemia Yes No
Thrombosis ↑ Risk Less
Underlying Podocyte / GBM injury Glomerular inflammation
Treatment IS + RAAS blockade + ACE/ARB Specific to GN + IS

339.2.3 Special Topics

339.2.3.1 Mixed Syndrome

  • Some GN have nephritic + nephrotic features
  • IgA nephropathy may have mixed
  • Lupus nephritis can be mixed
  • MPGN often mixed

339.2.3.2 Acute Post-Streptococcal GN (PSGN)

  • 2-3 weeks after strep pharyngitis or skin infection
  • ASO + anti-DNase B
  • Low C3 (returns to normal in 6-8 weeks)
  • Self-limited typically
  • Children > adults
  • Cola-colored urine

339.2.3.3 IgA Vasculitis (HSP — Henoch-Schönlein Purpura)

  • Children
  • IgA deposition
  • Purpura + abdominal pain + arthritis + nephritis (in some)
  • Treatment: supportive; steroids for severe

339.2.3.5 HIV-Associated Nephropathy (HIVAN)

  • FSGS variant (collapsing)
  • African American
  • Treatment: ART + ACE/ARB