A 40-year-old female with nephritic range proteinuria is found to have low serum complement levels. Which of the following can be the likely etiology? 1. Systemic lupus erythematosus 2. Post-infectious glomerulonephritis 3. Infective endocarditis 4. Mesangio-capillary glomerulonephritis Select the correct answer using the code given below:
Nephritic Proteinuria and Low Complement Etiology
The clinical presentation of nephritic range proteinuria combined with low serum complement levels points towards glomerular inflammation driven by immune mechanisms that activate the complement system.
Evaluating Potential Causes
Let's examine each condition:
- Systemic lupus erythematosus (SLE): SLE commonly causes immune complex glomerulonephritis (lupus nephritis). Immune complexes activate complement, leading to consumption and thus low C3/C4 levels. This fits the clinical picture.
- Post-infectious glomerulonephritis (PIGN): Often follows infections (like Strep). Immune complexes form and deposit in glomeruli, activating complement and causing nephritic syndrome. Complement levels (especially C3) are typically low during the active phase.
- Infective endocarditis: This condition can trigger immune complex glomerulonephritis due to circulating microbial antigens. Complement activation and subsequent consumption result in low serum levels, alongside nephritic symptoms.
- Mesangio-capillary glomerulonephritis (MCGN): Also known as Membranoproliferative Glomerulonephritis (MPGN). Certain types of MPGN are characterized by persistent complement activation (often via the alternative pathway), leading to chronically low C3 levels and nephritic manifestations.
Since all four conditions listed are known causes of nephritic syndrome with associated low complement levels, they are all plausible etiologies.
Conclusion: All the listed conditions (1, 2, 3, and 4) can cause the observed clinical findings.
Important Questions from Nephrotic Syndrome
- All of the following conditions are associated with Glomerulonephritis with low complement level, EXCEPT:
- Which of the following are the indications of Renal biopsy?
1. Chronic Kidney disease with normal sized kidney
2. Nephrotic syndrome in adults
3. Nephrotic syndrome in children with atypical features
Select the correct answer using the code given below: - Presence of Dysmorphic Erythrocytes in urine analysis is suggestive of:
- Of all the types of lupus nephritis, the worst outcome is seen in:
Match list I with list II and select the correct answer using the code given below the lists:
List I (Urine exam) List II (Disease) A. Red cell casts 1. Nephrotic syndrome B. Microscopic haematuria 2. Chronic renal failure C. Proteinuria 3. Polycystic kidney disease D. Broad cell casts 4. Glomerulonephritis
