GLOMERULAR SYNDROMES

LIGIA PETRESCU

BACKGROUND
This class of kidney disease centers around the glomerulus.

This is where the main filtration of the nephron occurs and is located within the Bowman's capsule.

CLASIFICATION

ACUTE NEPHRITIC SYNDROME RAPIDLY PROGRESSIVE GLOMERULONEPHRITIS NEPHROTIC SYNDROME ASYMPTOMATIC HEMATURIA OR PROTEINURIA CHRONIC GLOMERULONEPHRITIS
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ACUTE NEPHRITIC SYNDROME

DEFINITION AND CLASIFICATION
Acute nephritic syndrome is a group of disorders that cause inflammation of the internal kidney structures (specifically, the glomeruli), often caused by an immune response triggered by an infection or other disease. It is characterized by edema, high blood pressure, the presence of red blood cells in the urine, red cell casts, proteinuria, renal failure. Nephritic syndrome can develop suddenly or over a short time period (acute nephritic syndrome) or develop and progress slowly (chronic nephritic syndrome).
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ETIOLOGY PRIMARY GLOMERULOPATHIES

ACUTE DIFFUSE PROLIFERATIVE GLOMERULONEPHRITIS RAPIDLY PROGRESSIVE (CRESCENTIC) GLOMERULONEPHRITIS MEMBRANOUS GLOMERULOPATHY MINIMAL CHANGE DISEASE FOCAL SEGMENTAL GLOMERULOSCLEROSIS MEMBRANOPROLIFERATIVE GLOMERULONEPHRITIS 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

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 infections such as, hepatitis C, B, HIV parasitic infections such as malaria.

HEREDITARY DISEASES
ALPORT SYNDROME THIN MEMBRANE DISEASE FABRY DISEASE

OTHERS
Primary gravidic nephropathy Mixedema Dermatological diseases Obesity

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 of acute kidney failure

Urine appearance and color are abnormal (coca-cola)

Urinalysis nephritic urinary sediment reveals variable number of red blood cells (RBCs), WBCs, and RBC casts (pathognomonic of active glomerulonephritis) Protein in the urine test is positive; Proteinuria is usually modest, ranging from 2 to 6 g in a 24-hour collection
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SIGNS AND TESTS

kidney biopsy
confirm the diagnosis, determine the cause, determine the amount of scarring potential for reversibility.

A biopsy, is rarely performed in advanced stages, when the kidneys are shrunken and scarred, because the chance of obtaining specific information about the cause is small.
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SIGNS AND TESTS

Tests for the cause of the acute nephritic syndrome may include:
Culture of the throat or skin Blood culture ANA titer (lupus) Serum complement (C3 and C4) ANCA (antineutrophil cytoplasmic antibody for vasculitis) Anti-glomerular basement membrane antibody

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Chronic Glomerulonephritis

The urinalysis demonstrates a few RBCs and WBCs but is 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 Progressive Glomerulonephritis

This condition is distinguished from acute glomerulonephritis by the rapid loss of renal function, which is defined as a rise in the serum creatinine concentration of more than 2 mg/dl over a 3-month period.

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Rapidly Progressive Glomerulonephritis

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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