curs 01 engleza glomerular syndromes

7/30/2019 Curs 01 Engleza Glomerular Syndromes

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GLOMERULAR SYNDROMES

LIGIA PETRESCU


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BACKGROUND

This class of kidney disease centers around theglomerulus.

This is where the main filtration of thenephron occurs and is located within theBowman's capsule.


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CLASIFICATION

ACUTE NEPHRITIC SYNDROME

RAPIDLY PROGRESSIVE

GLOMERULONEPHRITIS NEPHROTIC SYNDROME

ASYMPTOMATIC HEMATURIA ORPROTEINURIA

CHRONIC GLOMERULONEPHRITIS


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ACUTE NEPHRITIC SYNDROME

DEFINITION AND CLASIFICATION

Acute nephritic syndrome is a group of disorders thatcause inflammation of the internal kidney structures(specifically, the glomeruli), often caused by an immuneresponse triggered by an infection or other disease.

It is characterized by edema, high blood pressure, thepresence of red blood cells in the urine, red cell casts,proteinuria, renal failure.

Nephritic syndrome can develop suddenly or over a shorttime period (acute nephritic syndrome) or develop andprogress slowly (chronic nephritic syndrome).


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ETIOLOGYPRIMARY GLOMERULOPATHIES

ACUTE DIFFUSE PROLIFERATIVEGLOMERULONEPHRITIS

RAPIDLY PROGRESSIVE (CRESCENTIC)GLOMERULONEPHRITIS

MEMBRANOUS GLOMERULOPATHY

MINIMAL CHANGE DISEASE

FOCAL SEGMENTAL GLOMERULOSCLEROSIS

MEMBRANOPROLIFERATIVEGLOMERULONEPHRITIS

IgA NEPHROPATHY

FOCAL PROLIFERATIVE GLOMERULONEPHRITIS

FIBRILLARY GLOMERULOPATHY


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SYSTEMIC DISEASES

COLAGENOSIS (SLE)

DIABETES MELLITUS

AMYLOIDOSIS GOODPASTURE SYNDROME

POLYARTERITIS NODOSA

WEGENER GRANULOMATOSIS

HENOCH-SCHONLEIN PURPURA

BACTERIAL ENDOCARDITIS


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INFECTIOUS DISEASES

Bacterial infections post-streptococcal glomerulonephritis typically

develops following a throat or skin infection in

children between the ages of 2 and 14.

viral infectionssuch as, hepatitis C, B, HIV

parasitic infectionssuch as malaria.


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HEREDITARY DISEASES

ALPORT SYNDROME

THIN MEMBRANE DISEASE

FABRY DISEASE


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OTHERS

Primary gravidic nephropathy

Mixedema

Dermatological diseases

Obesity


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PATHOGENESIS

ANTIBODY MEDIATED INJURY: Goodpasture antigen(anti-GBM nephritis)

IN-SITU IMMUNE COMPLEX DEPOSITION

CELL MEDIATED IMMUNE INJURY

Rejet nephropathy


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SYMPTOMS

fluid retention and tissue swelling (edema)

low urine volume

dark urine that contains blood (coke-like)

Blood pressure increases

kidney failure


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SIGNS AND TESTS

There may be signs ofacute kidney failure

Urine appearance and color are abnormal (coca-cola)

Urinalysis nephritic urinary sediment reveals variablenumber of red blood cells (RBCs), WBCs, and RBCcasts (pathognomonic of active glomerulonephritis)

Protein in the urine test is positive; Proteinuria is

usually modest, ranging from 2 to 6 g in a 24-hourcollection
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SIGNS AND TESTS

kidney biopsyconfirm the diagnosis,

determine the cause,

determine the amount of scarring

potential for reversibility.

A biopsy, is rarely performed in advancedstages, when the kidneys are shrunken andscarred, because the chance of obtainingspecific information about the cause is small.
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SIGNS AND TESTS

Tests for the cause of the acute nephriticsyndrome may include:

Culture of the throat or skin

Blood culture

ANA titer (lupus)

Serum complement (C3 and C4)

ANCA (antineutrophil cytoplasmic antibody forvasculitis)

Anti-glomerular basement membrane antibody
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Chronic Glomerulonephritis

The urinalysis demonstrates a few RBCs and WBCs butis mostly nonspecific.

A variable amount of proteinuria is present.

Kidney size is typically small, reflecting the presence

of advanced fibrosis and glomerulosclerosis.


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Rapidly ProgressiveGlomerulonephritis

This condition is distinguished from acuteglomerulonephritis by the rapid loss of renal

function, which is defined as a rise in the serumcreatinine concentration of more than 2 mg/dl

over a 3-month period.


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Rapidly ProgressiveGlomerulonephritis

This syndrome needs to be recognized early

so that renal biopsy can be done and

therapy instituted immediately.


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COMPLICATIONS

Acute kidney failure

Chronic kidney disease

High blood pressure

Congestive heart failure

Pulmonary edema
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curs 01 engleza glomerular syndromes

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