ii) acute gn definition (hricik et al, 1998) syndrome characterized by the abrupt onset of...
TRANSCRIPT
![Page 1: II) Acute GN Definition (Hricik et al, 1998) Syndrome characterized by the abrupt onset of macroscopic hematuria; oliguria; acute renal failure; manifested](https://reader035.vdocuments.us/reader035/viewer/2022062511/5514d533550346b0338b52d2/html5/thumbnails/1.jpg)
II) Acute GNII) Acute GNII) Acute GNII) Acute GN
Definition (Hricik et al, 1998)Definition (Hricik et al, 1998)
• Syndrome characterized by the abrupt onset of macroscopic hematuria; oliguria; acute renal failure; manifested by a sudden decrease in GFR; and fluid retention, manifested by edema and hypertension.
Definition (Hricik et al, 1998)Definition (Hricik et al, 1998)
• Syndrome characterized by the abrupt onset of macroscopic hematuria; oliguria; acute renal failure; manifested by a sudden decrease in GFR; and fluid retention, manifested by edema and hypertension.
![Page 2: II) Acute GN Definition (Hricik et al, 1998) Syndrome characterized by the abrupt onset of macroscopic hematuria; oliguria; acute renal failure; manifested](https://reader035.vdocuments.us/reader035/viewer/2022062511/5514d533550346b0338b52d2/html5/thumbnails/2.jpg)
Acute GNAcute GNAcute GNAcute GN
• Classically post-streptococcal although other infectious etiologies possible
• Acute pharyngitis followed 10-14 d later by acute nephritis (sodium and water retention, hypertension, ‘smoky’ coloured urine, fall in GFR
• Usually associated with low complement• Treatment is supportive• Prognosis generally good with spontaneous
resolution
• Classically post-streptococcal although other infectious etiologies possible
• Acute pharyngitis followed 10-14 d later by acute nephritis (sodium and water retention, hypertension, ‘smoky’ coloured urine, fall in GFR
• Usually associated with low complement• Treatment is supportive• Prognosis generally good with spontaneous
resolution
![Page 3: II) Acute GN Definition (Hricik et al, 1998) Syndrome characterized by the abrupt onset of macroscopic hematuria; oliguria; acute renal failure; manifested](https://reader035.vdocuments.us/reader035/viewer/2022062511/5514d533550346b0338b52d2/html5/thumbnails/3.jpg)
III) Nephrotic SyndromeIII) Nephrotic SyndromeIII) Nephrotic SyndromeIII) Nephrotic Syndrome
CaseCase
• 79 year old man, history of ureteric stenosis requiring stenting 8 years ago
• New onset edema, HTN• 24 hour urine – 13 g protein, cholesterol 11,
creatinine 135• Diagnosis?
CaseCase
• 79 year old man, history of ureteric stenosis requiring stenting 8 years ago
• New onset edema, HTN• 24 hour urine – 13 g protein, cholesterol 11,
creatinine 135• Diagnosis?
![Page 4: II) Acute GN Definition (Hricik et al, 1998) Syndrome characterized by the abrupt onset of macroscopic hematuria; oliguria; acute renal failure; manifested](https://reader035.vdocuments.us/reader035/viewer/2022062511/5514d533550346b0338b52d2/html5/thumbnails/4.jpg)
ProteinuriaProteinuriaProteinuriaProteinuria
MechanismsMechanisms
• Damage to glomerular BM/visceral epithelium• Impaired reabsorption by tubular cells• Secretion of protein from tubular cells• Filtration of an abnormal protein that is small
MechanismsMechanisms
• Damage to glomerular BM/visceral epithelium• Impaired reabsorption by tubular cells• Secretion of protein from tubular cells• Filtration of an abnormal protein that is small
![Page 5: II) Acute GN Definition (Hricik et al, 1998) Syndrome characterized by the abrupt onset of macroscopic hematuria; oliguria; acute renal failure; manifested](https://reader035.vdocuments.us/reader035/viewer/2022062511/5514d533550346b0338b52d2/html5/thumbnails/5.jpg)
Nephrotic SyndromeNephrotic SyndromeNephrotic SyndromeNephrotic Syndrome
![Page 6: II) Acute GN Definition (Hricik et al, 1998) Syndrome characterized by the abrupt onset of macroscopic hematuria; oliguria; acute renal failure; manifested](https://reader035.vdocuments.us/reader035/viewer/2022062511/5514d533550346b0338b52d2/html5/thumbnails/6.jpg)
Nephrotic SyndromeNephrotic SyndromeNephrotic SyndromeNephrotic Syndrome
![Page 7: II) Acute GN Definition (Hricik et al, 1998) Syndrome characterized by the abrupt onset of macroscopic hematuria; oliguria; acute renal failure; manifested](https://reader035.vdocuments.us/reader035/viewer/2022062511/5514d533550346b0338b52d2/html5/thumbnails/7.jpg)
Nephrotic SyndromeNephrotic SyndromeNephrotic SyndromeNephrotic Syndrome
Definition (Screiner, 1971)Definition (Screiner, 1971)
• “A clinical entity having multiple causes and characterized by increased glomerular permeability manifested by massive proteinuriaproteinuria and lipiduria. There is a variable tendency towards edemaedema, hypoalbuminemiahypoalbuminemia and hyperlipidemiahyperlipidemia. Protein excretion rates are usually in excess of 3.5 g/day/1.73m2 body surface in the absence of a depressed GFR.”
Definition (Screiner, 1971)Definition (Screiner, 1971)
• “A clinical entity having multiple causes and characterized by increased glomerular permeability manifested by massive proteinuriaproteinuria and lipiduria. There is a variable tendency towards edemaedema, hypoalbuminemiahypoalbuminemia and hyperlipidemiahyperlipidemia. Protein excretion rates are usually in excess of 3.5 g/day/1.73m2 body surface in the absence of a depressed GFR.”
![Page 8: II) Acute GN Definition (Hricik et al, 1998) Syndrome characterized by the abrupt onset of macroscopic hematuria; oliguria; acute renal failure; manifested](https://reader035.vdocuments.us/reader035/viewer/2022062511/5514d533550346b0338b52d2/html5/thumbnails/8.jpg)
Nephrotic SyndromeNephrotic SyndromeNephrotic SyndromeNephrotic Syndrome
Differential DiagnosisDifferential Diagnosis
• Minimal change• FSGS• Membranous• MPGN• IgA• nodular – amyloidosis, DM, fibrillary
Differential DiagnosisDifferential Diagnosis
• Minimal change• FSGS• Membranous• MPGN• IgA• nodular – amyloidosis, DM, fibrillary
![Page 9: II) Acute GN Definition (Hricik et al, 1998) Syndrome characterized by the abrupt onset of macroscopic hematuria; oliguria; acute renal failure; manifested](https://reader035.vdocuments.us/reader035/viewer/2022062511/5514d533550346b0338b52d2/html5/thumbnails/9.jpg)
Nephrotic SyndromeNephrotic Syndrome
![Page 10: II) Acute GN Definition (Hricik et al, 1998) Syndrome characterized by the abrupt onset of macroscopic hematuria; oliguria; acute renal failure; manifested](https://reader035.vdocuments.us/reader035/viewer/2022062511/5514d533550346b0338b52d2/html5/thumbnails/10.jpg)
Minimal Change DiseaseMinimal Change DiseaseMinimal Change DiseaseMinimal Change Disease
![Page 11: II) Acute GN Definition (Hricik et al, 1998) Syndrome characterized by the abrupt onset of macroscopic hematuria; oliguria; acute renal failure; manifested](https://reader035.vdocuments.us/reader035/viewer/2022062511/5514d533550346b0338b52d2/html5/thumbnails/11.jpg)
FSGSFSGSFSGSFSGS
![Page 12: II) Acute GN Definition (Hricik et al, 1998) Syndrome characterized by the abrupt onset of macroscopic hematuria; oliguria; acute renal failure; manifested](https://reader035.vdocuments.us/reader035/viewer/2022062511/5514d533550346b0338b52d2/html5/thumbnails/12.jpg)
Membranous Membranous NephropathyNephropathyMembranous Membranous NephropathyNephropathy