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"ITP with nephritis" is a clinical scenario where two distinct conditions are present:
1. Immune Thrombocytopenic Purpura (ITP):
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An autoimmune disorder where the immune system attacks and destroys platelets.
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Leads to thrombocytopenia (low platelet count) and increased bleeding risk.
2. Nephritis:
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Refers to inflammation of the kidneys, which can manifest as:
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Hematuria (blood in urine)
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Proteinuria (protein in urine)
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Elevated creatinine
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Edema and hypertension in some cases
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Clinical Significance of ITP with Nephritis:
This combination is unusual and often points toward an underlying systemic autoimmune disease, most commonly:
Systemic Lupus Erythematosus (SLE):
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Common link between ITP and nephritis.
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Can present with both immune-mediated thrombocytopenia and lupus nephritis.
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Additional features: ANA positive, anti-dsDNA, low complement levels (C3, C4), rash, arthritis, etc.
Other possible differentials:
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Antiphospholipid Syndrome (APS) – especially if thrombosis is involved.
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Vasculitides (e.g., ANCA-associated)
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Drug-induced (e.g., certain medications can cause both thrombocytopenia and interstitial nephritis)
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Infections (e.g., hepatitis C, HIV, EBV)
Investigations to Consider:
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Full blood count and blood film
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Renal function tests and urinalysis
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Autoimmune panel: ANA, dsDNA, ENA, complements
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Hepatitis and HIV serology
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Renal biopsy (if indicated) – for exact classification of nephritis
Management Overview:
Depends on the underlying cause, severity, and organ involvement:
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Steroids are often first-line for both ITP and nephritis (especially in lupus)
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Immunosuppressants: Mycophenolate, cyclophosphamide, rituximab, depending on severity
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IVIG or platelet transfusions for severe ITP
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ACE inhibitors or ARBs for proteinuria
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Close monitoring of renal function, proteinuria, and platelet counts
If you have more specific clinical context (age, underlying disease, test results), I can tailor the explanation and management approach further.
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