Professional Documents
Culture Documents
The Nephron
• Consists of the glomerulus and its attached
tubules.
• The functional unit of the kidney.
Major Renal Syndromes
• Acute Nephritic Syndrome
• The Nephrotic Syndrome
• Rapidly Progressive Glomerulonephritis
• Asymptomatic Hematuria or Proteinuria
Major Renal Syndromes (cont)
• Acute Renal Failure
• Urinary Tract Infection
• Nephrolithiasis
Acute Nephritic Syndrome
• Sudden onset of hematuria with RBC casts and
renal failure (days - weeks)
– RBC casts not listed in the book!! But this is critical!!
• Proteinuria (mild to moderate but NOT Nephrotic
Range)
• Hypertension
• Hallmark Disease: Post Streptococcal
Glomerulonephritis
What is an
RBC cast?
The Nephrotic Syndrome
• Proteinuria (>3.5gm/day)
• Hypoalbuminemia
• Edema
• Hyperlipidema
• Lipiduria
Rapidly Progressive
Glomerulonephritis
• Nephronal hematuria
• Renal failure developing over weeks to months
• Diffuse glomerular crescent formation.
Asymptomatic Hematuria or
Proteinuria
Mesangium
Normal Glomerulus EM
Capillary Space
GBM
Endothelium
Podocyte
Urinary Space
Podocytes
Glomerular Function
• Glomerular filtration
– barrier
– charge
Pathogenesis of Glomerular Diseases
• Immune mechanisms
• Non-immune mechanisms
Immune Mechanisms of Glomerular
Disease
• Board Hint:
– Basement membrane antigen in Good Pasture’s -
Alpha 3 chain of collagen type 4
Heymann’s Nephritis - Membranous
GN
• Proteases
• Reactive oxygen metabolites
• Arachidonic acid metabolites
Other Mediators
• Cytotoxic antibodies
• Macrophages
• Platelets
• Resident glomerular cells
• Fibrin related products
Other Mechanisms of Glomerular
Injury
• Epithelial cell injury
– “X” - factors
– resulting in epithelial cell detachment
– proteinuria
• Renal ablation glomerulopathy
– fall in GFR
– leads to end stage renal failure