1-Introduction to Nephrology, Glomerulonephritis (2)

7/25/2019 1-Introduction to Nephrology, Glomerulonephritis (2)

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ة ي .AB CCNephrology Dr ا68@ .? ر5< ا (= ا> ا ; بEl-Hawary

م رD ي رD( ا ه ا ل E م اي )2 ي س ل س F ا ( ر 9 ر ى أ ل ا GHE ع ا IHJ و KL ا - ( ي و ه ا *() ل

! م أ -) م ل س ه و ص * ب ىM ه و ل ع ه و ي ل ه ع ل ى ا ل *() صم ل س ه و ي ل ه ع ل ى ا ل ه ص ل L س = ا ق

=@ ى رD K & ف N ه رO P ف ل R هQ ي ب نS5(D ف T) ا س ر ه ا ل 2' ر اA ل ي U ق ل هR5 # VH! O& ع هO وD KL & ف N ه ي N? W ي ف N ه ن أ

Xة رO و Z وG ا Y( ع 8 #I ا ص * ة و هO و ن \H] ا -(& ل $ م E له ي ل ه ع ل [ ا ر ه ف ت 2 ي % 2 ا )2 ي U م و .* ي _ وL ̂ا >ع =.U م ف `هO و A ت % # مa5. ه ا )2 ي هO و ي ن ي رO P و ج -& ف N رP ي ع أ

ه هO و أ. ت ب ل رO P و ج -& Q ن P ف ق ه أ ل ه ج (T ا ت b\ رI 2 ي % 2 اL اQ( ة ا )2 ي و@

و ا ! ر (56 $V(*) ا c 2 8ب رQ ي cA ا L(J) $ ا ت c$ص * ي d ا V(*) 0 م اDة $ ص * ي H\dص

ى لر% ل e رIا S 2 ا ZY+.? ر5<,, 2 ب )ا 8وا (* fفا ا9 ر

nephrology L= ل )% ت g5 ا U= اL 9 ررKفوh2 ل UJ 5 ي L E ن ق ق أ تو ا - ا E ع,, > = ق ر ي ij Nا >قف lا E ب ,, G=5ع J رkا 5ijmo= ي = mnا (= ا

ل9 +@ ن 0(& ,,glomerulonephritisافات *)D ن ل.0 ل ( ن> = ق ق = نGNاع U2bilateral and symmetrical ,, و

<< mainly immunologically mediated

لا.0 ل ( ن%)Pو -) etiologyاعP ن E) ق $و

•Primary•secondaryا أ@ Primaryو

$pathogenesisاق E( نو -)5 •Immunologically mediated•Non immunologically mediatedا أ@ immunologically mediatedو

ف ,,immunologically mediatedاوpp أ@ immune complexا

ق ? ن ن )و %)Pع




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لا - ن = ا ,,%)P -)ا,,classifcationا

rأ2= ا q أGNT Lاي EN(= ا ت EN ي ( ,,ات EN ي ( • 8وا لا etiologyاAEDعت EN ي ( • ت 2 يا لا tت qا (s L E 5- نcourseاAEDع >Pا ( ر ppHow rapid the deteriorationuت EN ي ( • لا S S ا لاs 5 % 8 5- نdistributionاAEDع ا

&J* ي U ي aف ection&J* ي ,, U ي uت K Uفت EN ي ( • ا - ا ر لا pathologyاAEDع

و لD جأ ت etiologyqاAED,, ع ,,GNا ت etiologyqاق = نD ن Primary and secondaryق E( ن P,, و% نGNا

ت etiologyqا ,,glomerular in!uryا PrimaryP< ppIdiopathic << confned to the "idneyاق = ن•ا• ppmultisystem disorderج secondaryP< pp+Zو

و5 ب N ى ن @ .EN ي ( أ ف ر Primary and secondary,,ع

ل.EN ي ( . 2 ت courseqاAED,, ع ,,GNا ت )@=glomerular in!uryP< Lا ق في 5vvv أ>و

ه r. ل ي ج Dافcourse$•#cute•$ubacute•%hronic

فpp ي *glomerular in!ury&Jاpp - ن @ acute GNق = 2 =

H\I( 1Iر ج )kق J يw N ت ي TأG 5ت س sdays to wee"suأ

I( 1فpp ي *glomerular in!ury&Jاpp - ن @ chronic GNق = = ة ج )Bk=5 ل

L=U9ي ن smonths to yearsuس

س _D جpp - ن @ subacute GNق = = I( 1فpp ي *J&وT ي س L=U9swee"s to months )E.1 pp urapidly progressi&e أ

ت 0 ر ,,%)Pف\ ت PGNP< L J'% ل ( ة pprapidly progressi&e glomerulonephritisا



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= x ل ر 5q- نrapidly progressi&e glomerulonephritissrapidly$ق = ت س أ

chronicu -)@ ل(J ق = ق ل,, ت * J&أ ي y( Tع س L=U9 أ

س _و> acute and chronicايوk - ب Bq ر س I(Dأ ا I(D,, أ% تو ا رIو ,,ج )k\; ي

ق \ppH فacute GNا ق J يو

chronic GNfا و ر لpp @ ت chronic renal )ailureاعا س _subacute GNو ييpp و 8. ن ا

F .- ر ,, >اk )5وى y( days to wee"s << acuteل

*ays to months << subacute+onths to years << chronic

ه rي ,,. 2 ي.EN ي ( ى لا AED Zل ت )@=L ا يت glomerulusاف

L=@( ت 5vv 5- نتIn,ammation and in!ury

ل EN. N ي ( . ,,distributionاAED,, عي5- ن لا (0 ف zا ي glomerulivvاف

< )U و و و ت EN ي ( فأ ع ا GNات

ه ن )ي idney-ا فdistributionعه ي ن )ف glomerulusا فdistributionع

P<vvا 5GH0 5- ن,, x\ ل

ت 2 يت EN ي ( ة ت 0 لu ,, % نscourseا ي U ن ت )@=s L 6 ا Z عف uاتت EN ي ( ة ت ت 0 لsdistributionا لu ,, ن ا (0 ع

I(D ا 6I(D و ا و 0 ,, و

ا (idney 0-افا (0 glomerulusافو

,,F={2.- = او ,,idney-ا,, فD جأ

aا05= (0 ection$•*i use



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•/ocal

[5 ه di% ل ( يا ? ر use )ocalvve* ة ا ل ?|و ,,ا*i use5- ن ppa ecting the ma!ority o) the glomeruli }- sاglomeruliuي = = 5- ن ppa ل ectأ% ت ~j •

/ocalت D ppI<(* s+inority& ق •pp u~j أ

] di% ل ( يا ? ر use )ocal,,~jق &,, أ• أ% ت • j~أ

,,Glomeruliا,, فD ج. 2 U)EN ن$

•Global•$egmental

Global5- ن ppa ecting almost all o) the glomerulus .N ر5 بglomeruluskا%&

$egmental5- ن ppa ecting only some parts o) the glomerulus glomerulusاD ت

B >ا E بI(5(9,,ن E بdistributionا & "idney << di use and )ocal

&0%W 2 = r(\ N اglomerulusP<ت,, و DIر وص R ي و و اأ

"idney glomeruli U)EN.ppglobal and segmentalا

ه tي ا ر di.-(&أ useي ف ocal(5-(&,, وه tي ا ر يglobal.-(&أ ف t,, و ا ر segmental.-(&أ

ت R 5 5 ب N ى rق = أ2 > = ق ت EN ي ( ,,ا

ى etiology 00 primary and secondaryاAEDل ى course 00 acute0 subacute and chronicاAEDلى idney and glomeruli-ا,, فdistributionاAEDلidney << di-اف use and )ocal glomeruli << global and segmentalاف

ن )5 ت ?'& ت EN ي ( ع ا - ا ر ,,ا



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ى ,,pathologyاAEDلة جا Y 5 ا * ت >ا ZY^ ي فGNات qا )P<wL,, @= . ر% ي Z * ت

Z ل. ر% ي لع ع \ @(E و#% ل ( و#,, ? ي €س ( ت * = E ت =yأ

ت pathologyqا ,,GNا &%P<*.ن = ا classifcation o) GN etiology0 course0 distributionاعand pathology 3

pathology .8ا لdamageا,, s 5- ن% يJD& ا ينu ف $2= ع•Non proli)erati&e•Proli)erati&e

] 5vv ا ? رI(D% ل ( ة ا يو Increase in glomerular cell number ? ي €و#pp فع cellsاع )> glomerulusrا ت ر #و#pp % بلIn,ammationا = cellافglomeruliP - ppI< 56افJD& ا

number 5Proli)erati&e ب N ى

‚=U-) N ب . ppnon proli)erati&e (Dا ل,, وB 5 ي N5$A= و اh5(D لا ن )Pو افت K Uع

glomeruli ف ,,cell number(5Z5vv 5growth )actors; ل in,ammation 0) Tا8ا cell numberا فgrowth )actors 0) &)-.proli)erationو

E.1 ppProli)erati&e( 6 ا>pp ع )>@ glomerular cellsا = erati&e(ppNon proli 5 ب pp‚<Z N ع )>@ glomerular cellsا =

ه tي ا ر ,,non proli)erati&eت -(&أه ي tف ا ر Proli)erati&eت -(&أ

A ي B,,xE)2اا8و#2 يف ,,Non proli)erati&e,,

r. ل @( ج D,,ي U م diف use U ي ف ocal( وى ق & s أ% تdistributionاAEDل أ • ju~وت EN ي ( ج = .EN ي ( >5 ب N ى ,,ا

أ2 لت 0 لو ي Non proli)erati&e Uاع sdi ف use U ي ف ocalu( و




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W ي QProli)eration sي QI< 56<( اعcellsu

diا use N ب ي ت $2= ع•+inimal change GN•+embranous GN

ا ocalq=2$(و•/ocal segmental glomerulosclerosis

/ocal,,\)5- ن ا D€ di ت و useIL= ت ن idney"اف,, تت =5IL- نsegmentalو ن glomerulusافت

ل `ƒ,, @ ن } رD } رD ن E ‚=U ه ت ?J ي &ا

ي h.x ل5 ب N ى ن )„ف ,,Non proli)erati&eافأVH!q=2عي diا. ب 2T= ع useq=2و ,,T ا. ب)ocal diا use << minimal change GN 00 +embranous GN

ocal << )ocal segmental glomerulosclerosis(ا ل U م تج ت ?J ي &@ ن } رE ,, UD > = ق (- 5=9ƒ` ل ا

,,Proli)erati&eا ي5- ن cell numberافI< 56فر>Proli)erati&eا U ي di,, ف use )ocal

*i use5- ن ppa ecting more than 5 6 o) the "idney /ocal5- ن ppa ecting less than 5 6 o) the "idney

W ل ?= >و ,,non proli)erati&eاعي h تي2 ه the glomeruli (cell numbers oاع )>فI< 56ف

ه ن )2 ي ,,Proli)erati&eاف@ نعT ا. بdi use$

•+embrano7proli)erati&e GN•+esangio7proli)erati&e GN•%rescentic GN•*i use proli)erati&e GN

ل $ocal(ا. ب Tاس (D U ج• Ig# nephropathy or 8erger9s diseaseا

2 تي U >ع =Iل €0,, > = ق



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(- W)\l5 ق <xE ) ن @ ,,I(D ا I(Dو ا ل `ƒو ي U ,, 2 ت 0 لا ل ت ?J ي &ع و و و

ن ي لxE)2ا8و\ ل ,,ف =[ا U}?D ا س (* ل = ا ,, Non proliferative,,

diا use U ي M,, ف inimal change ,,Membranousي ocal U(ا ocal segmental glomerulosclerosis(,, ف

ا ل 0 ن ,, proliferative,,diا useG6# s ,, N 5 ب U ي u@ ن }=proli)erati&e 6F% ل ( ف

• U ي embrano7proli)erati&e+ف• U ي ف esangio7proli)erati&e+و• U ي ف ‚rescentic GN%و U ي ? s ) ل %proli)erati&eW 2 ي ل

proli)eration 6 =N ت@ ن ل9 +> = ق uا • U ي ف i*و use proli)erati&e ,,ocal(ا

•Ig# nephropathyي ocal,, u(D تف *)>sproli)erationW I فم ت s 2 ا…س س8erger9s diseaseا ج & ا ا ر لا ص ?U ا uو

ن = ا.*>و%& ي proli)erati&e Uع sdi ف use )ocalu&%I(D ا fو ن } ر ل `D= ƒ)@ @ ت ا

,,>Proli)erati&ePا ي € ا@( vcell numbervv 5†† أincrease in cell number U2ف

glomerular cell numberو ( ل ر ق = @ ب N 05 ب ي U أ ل proli)erationvvvعى ,,B ب - AEDkلو ,,>proli)erati&ePافD جأ

Huge in ltration of the glomerulus by the in ammatory cells (neutrophils andmonocytes)

(Dا ن )H k S Pو ,,D تفت K Uعب N ى hea&ily infltrated by neutrophils and monocytesي

9 ‚in,ammationأ6 U ج,, ? ي D

0 ,,لD جأ@ م ,,ج 5 ا

Proliferation of resident glomerular cells

5resident glomerularvvv 5- نيcellsا ل ا8ص



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,, x\ ل,,>glomerulusPا يج ل ل = ج =>cells€ Iع neutrophils and monocytesا@ pp ا

vv>ا 5Hh يج يع } ت K Uف 0 ,,يcellsا%( ل glomerulus << proli)erateاف,, ا (= ج =>I ا8ص

س ; ة growth )actors = ا

يcellsاي ل ل ا8ص ي JD U&ا لproli)erationvvاف JD& ( ا U ي ت Proli)eration Uف proli)erati&e GNvvv س ( يT ج ,,introduction &2 ر

$%)E5P(=@ م •Intracapillary proli)eration•xtracapillary proli)eration

intracarpillaryppا اendothelium@( ل و

mesangial cellsextracapillaryppا ع epithelial cells@( ل ت

8owman9s

T ج س ( 2 ر ر يل ل 8ص ,,ان ) ,,endothelialعلmesangial cellsو ا@ s ا

connecti&e tissueu

,,8owman9sافو -)5 Pير ج = parietalف ي,, و ف

&isceral

,,F={2.- = ا J*5Proli)eration ل U % ل cells< Uاي% 2= = 8. ن يmesangial cellsا sendothelial cells>وا 8. ن >وs u ا

س (U م intracapillary proli)erationuافcapillary << Intracapillary proli)erationاج = >ا 1 0 ت s‡- A و ب xا 05 ت

endocapillary proli)erationu



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0 ,,اisceral epithelium&ا - @ GNا% = parietal epithelium و

ل@( ي U ا رProli)eration )E.1 ppextracapillary proli)erationPف sا

capillaryu

extracapillary,, أintracapillary% س = ا+kاEN.proli)erati&e GN€ sNon proli)erati&e GNu ي ( .*% ل U م

A ي B,,ه cells<(5Z.vvا ت h لin,ammationاي

growth )actorK ppstimulate the proli)eration o) the cellsي ; ل Tع }

,,Non proli)erati&eا‚=U ي ? growth )actorT ت ; ل

A ي B,,non proli)erati&e %G %q=2vvvا H. u+inimal change 00 membranous 00 )ocal segmentalu. ة

ت@ ن U =N م ل9 +> = ق ا

لت 2 ,,Proli)erati&e@= ,, اr ج Dي و% ت و و أ

diا useG6# s ,, N 5 ب U ي u@ ن }=proli)erati&e 6F% ل ( ف•

U ي ي embrano7proli)erati&e • U+ف ف esangio7proli)erati&e+و• U ي ف ‚rescentic GN%و U ي ? s ) ل %proli)erati&eW 2 ي ل

proli)eration 6 =N ت@ ن ل9 +> = ق uا• U ي ف i*و use proli)erati&e ,,ocal(ا


A ي B,,يmesangial cellsا cells<(5Z.sendothelial cellsاproli)erati&e 5% ل ( - نف U( نD ن5 ب N ى 8. ن s u اس (U >و intracapillary proli)erationuا

اs&isceral epithelium ا.cells<(5Zا5 parietal epitheliumu ول@( ي U ا رProli)eration )E.1 ppextracapillary proli)erationPف sا

capillaryu




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ت EN ي ( >5 ب N ى رIا 8\ ي ع ا Pathologyات

ت R 5 5 ب N ى Dvvv ج% Gق E( ن @ D ن> = قT Lأr ج D$ etiologyاEN.AED ي ( •

courseاEN.AED ي ( • distributionاEN.AED ي ( • pathologyاEN.AED ي ( •

xE)2 N اpathologyل,, و2 ت 0 ل I(Dع ا I(Dو ا ,,و )@G %I(D ا vvو\(non proli)erati&e Eف.H. ة .( 2 ي5 ب proli)erati&e N,, و

(Dا و س ( .E- 5 ب N N= ن U=‚%( و schronic GNu ا

Z5 لأ.0 لع لE.pathology+ 9- ع ,,او x\ ل I(D,, أ ا inimal change GN+و

+inimal change GNNon proli)erati&evvا و#Proli)erati&eا. ب minimalP< %Tا T ا. بNon proli)erati&e

ل5 ه yا يي Y ر vvvف ,,وNon proli)erati&eا ى Dpp+inimal change GN ج أ ‚pathologyاpp @ نinimal+% ل ( - ن ن ب ي light أ )kأ )kأ )k ب

microscopy ب% لpathologyا biopsyt ت Y ي و icroscopeu+ 5 بs ا (? ر

لnormal fltrationا D ن ا6vv ات (} ق = ن @ capillary lumenا

proximal tubules وk Lا glomerular fltration رbarrier <اوcellsل ق = ن @ D ن ا

لي -) $@ نbarrierاع•$i>e•%harge

q= اتPodocytes




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و اD)أ ي non proli)erati&e Uاو sdi ف use )ocaludiا use minimal change 00 membranous 3

ocal )ocal segmental 3(ا

و و> ن U @ ت 0 ل.H. أ ل9 +ع ا و اD)أ pp+inimal س (=inimal changeP+او‚28 ه ن ب ي pathology << &ery minimalافD s جight microscopy? ب

u W electron microscope. ب

inimal change GNvv+ا فpathologyا5 ه 5 - ,,

= r(\biopsy ا-idney U ت D; ي س K=0.*,, و و ا ( ي 0 ر

و U =N. pp % ل ( أnothing by light microscopy

ight microscopeu? . ب D جs ? ي €G6#G6#2-( لelectron microscope

W 5ل electron microscopeF=9افأ ( 5 ب ا 5vv 5 ,, أ9= ف ( ل ق = أ يأ ل inimal change GNvv+ع

GH0 اP< =@ U) فا J* اk( ج,,ل1 ,,>oot processes(اع

&JDloss o) )oot processes o) the podocytes

س x\ ل >ا *0 5 ,, اdi use e acement o) the )oot processes o) the podocytes

sdi use 28T ا. بdi use5- ن ppa ection in podocytes0 podocytes0podocytesل% ل, % ل %u

se acement5- نdE 4 4u

ب charges Nا,, @&%)Pع ( ل أ2 = vvv = ج =>I@ ت

س -Poresاو%( ,,# وى P(% ,,r - ن ن و. ي ر ب لا vv#و#.-)@ نا

(-.(-. ل Z وGعI< 56,, و ا

ل Z وGع5I< 56 5- ن vvvا =@t و rا (? ر ن و. ي ر ب vv#و#.-)>ا




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,,ت -)#€5 0 0) ,,I(D ا لE2 s بو ي ل Q ل _u . ت E رKق

ي - ا…E2 )ي & ن )Pا ; ب normal traceع

W ل \x ن L ,, 2 * ب .- س وى ي - ا…E2 فD ت\ ل 9r=5 ,, = ا ; ب ن و. ي .E ر ر رQ ا ,,ن ) chargeا,, وD ج si>e ZاD ج Z ع

r ع s‡- r س ن و. ي ر ب ت E رKا يت ج -u_\ 2 . U ,, ف 5 ر reabsorption.-( ل tubules Uا

#reabsorption ت -( ل tubules UارQ و ,,‡- r ن و. ي ر ب ا

Kر E ت ن Z ت ت ي ( و pp )E51Normal trace فG %P<اف@rinepp

ق & لm~jأ Gا ر عioفج س W5=%,,

tubulesا,, وD ج barrier ZاD ج Z رQ ع )Normal tracerا

Y 2 ي N ن @,,لPoresا =ˆ نD ن ( unegati&e ,, ا>Podocytesا@ s ا

charges ع e,,ت ) r. ب ن و. ي ر ب ن Z ا يت لا - ي 5 ب pp N ج )k% ت Y5 5vv ي

Hea&y proteinuria

rف N)5- ن ج D€ t و N?5)@ ا ( ? رHea&y proteinuria5 5- نvv

Nephrotic syndrome

ت patientqا5 ب N ى ,,minimal change GNا Presentن D 5` vv ن ي

Hea&y proteinuria nephrotic syndrome 3

) Y5ا…ت * فx =N5$اminimal changeي 5vvv ف

ن €$ D ج.N= ه ب electron . ب,, ight microscope 0? ت microscope

x =N5$ 5 @لا * ج electron microscopevvv . ب اacement o) the )oot processes

=@P<damage& glomerular

&@ U ي proli)eration<vvvف



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#

) &J*5e acement o) the )oot processesr ن و. ي ر ب . ت E رK,, انا - ي 5 ب N ى ل Y5Knephrotic syndrome ي

ع )x I\ ل ,,%)Pق ى 1 0 ل rأ% تع (= kا ج common << nephritic and nephroticاا *

syndrome

[5 ه Nephrotic and nephriticvvيا ? رI(D% ل ( ة ا ,,و

U =N@( ل ب ن U?.<L U(= ,, ع } \ ل `ƒا ا *Jا لو ا

ل9 +ج 5 ة ا•NephroticI ?J) ا pp .=? •NephriticI ?J) ا ppI<و(E 5vvv 5- ن,, %)P - ن5- ن = %nephrotic N 5 ب ,,r=? يي و% ت و و و أ

.nephriticr(Eا ,,pp اع } .r(Eو ن Z €ا لا * جي tا و ل. ن Z ? ر rine@ا@= pp ا

rine&N.sAliguriau@ا%( يpp 5 ب N ى

0 ,,nephroticr=?5 pprا ج Dt و ت ?=.€ا (? رr@ ل ن و. ي ر ب ا

[>P,, ع } x\ ل ر يج )U k ف ف ي = ,, و [ل ر Nephroticايفand nephritic

ا - ا ?0 رIفت 0 ل,, أ2 0

ى fأ2 ف 0 رIل P< 6fا (=q=e } ر diabetesا9 ر

ى ي E ت =yل Iا ( ج E ت ا )% ت =L ا ج €و ص - ب>ا…ت * ف,, 8ب U ر minimal change GNا P<+ost common in children

x =N5س ‰ ا+B%BC,, Šthe most common type of nephrotic syndrome in children



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P<ا+ost common pathology o) nephrotic syndromeا ppminimal changeGN

ن )BP?&% = 5 ب N ى ,,nephrotic syndromeعT ي ; ل @+inimal change most common pathology o) nephrotic in children 3

,,D ج. 2 +embranous GN

,, x\ ل Non proli)erati&eا.EN ي ( ف D E ن ف diا,, .*Non proli)erati&eاو use

ي ي *membranous&Jا 5vvv ف8. { ب _ { ب _ ب ,, >% ight? ت

microscopeW ,,&J* ي U ي ,,%)PفNo e acement o) the )oot process

ل5 ه JDvv&اي@ ي Y رglomerular basement membraneا ف

,,>Pا ( ن { ره JDstretch ل&JDي س (D U جف diا use 28 st diا ( ر use,, u?ea"y thic"ening5di 5- ن use lea"y thic"eningvvv

*i uset ر ,,di use€ pp)ocal اbasal membraneل JD ,,stretch 00 thic"ening h ت pp ي

FL ت h ع ,,ف @ 2,, ع W0ير وGي = س Tا 0 ب,, و Tي 0 ب ج )kج )kج )kج )x P< U k,, \ لا h ر

T اthic"ening and stretchGو ت = س ppT ا h ر

,,>Pا GH0ج )U k مت ).= س poresTا ( r=?.protein,, . ب

و. ي ر س ->Poresا,, @ ي Hق5-)@ ي Y ب رI 0( ي,, 5-) و ي % ب

,, x\ ل5- نchargevv و#si>eاأ@ ي أ@ chargeا

inimal change&J*5P - ppHea&y proteinuria+فا ي * ج. ي embranous GN 0) ,, Y+و $ا. ن




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• 5asymptomatic proteinuria = s€ ت se&ereu 0 ن• 5symptomatic proteinuria = s %nephroticu

ي 5vv - ن @ >وا 0 ل ( ت oss o) protein? - ن @ م

A ي Bا ,,minimal change %(N و. يف vvيرeاع } acement o) the )oot processes

W5=%,,اinimal change GN+اف membraneous GN,, و

ييs 5- نKloss o) proteinي Y ا - ي nephrotic syndromeuق = س

وج )Iت membranous 0) ,,€2=0ا و و أ

‚ N ب pp+oderate proteinuria . ب Nephrotic NتA ي B,,[5 ه moderate proteinuriavvvا أNephroticايا ? رر ق &أ% ت أ اŠ~G›و ر ع } ر5 اL8 - ف ج عو س

P<اPathologyق Lي ,,ا. نP<F ت } ,,light microscope ي

ي 8. ن ا ن = ا.*>وو Non proli)erati&e diع use

,,embranous+ا P<the most common cause o) nephrotic in adults A ي B,,ه embranousvvv+س (=@ ي

ت h ع } glomerular basement membraneاي

ة ت Non proli)erati&e << )ocal,,ت/ocal segmental glomerulosclerosis

,,F={2.- = او D)ocal and segmental glomerulosclerosis جأ

ب N ى D ,,W a ت%)DP تت ected€ s&%ا-idneyu ب idney2 % pp N-ا%&% 2 = di@ ت use

/ocal5- ن ppIn&ol&ingا ppminority& ق • j~ أ

W 5 pathologyvvا,, س K=0.*أ ( F=9ا ( ي 0 ر 5vvv ,, أ




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F=9 sfbrosis and scarringu 5- نsclerosisأ

A ي B,, P<<L&- افin,ammation T اin,ammation N ب ي ي fbrosis and scarring F=9ف أ diabetesا9 بdeposition o) hyaline material و

ي 8. ن ن =qف,, ي *J ل = sclerosis and hyalinosis,,>وا ,,>Pا

A ي B,,ƒا embrane+ا,, ي E0 { ب =P<Œا GH0% و

لف - ي Y5damage o) the glomerular basement membrane ي

ل5 ه damagevvع ( لاsclerosis and hyalinosis 6 ,,&JDافdiabetes

وsclerosis and hyalinosisا glomerular basement membraneا ي E0 ر

W Pو يي E0 ر vvفق & *)و>DI تف • j~,, أ

A ي Bا . ت membraneP< E0اD ت ( E5 5vv ب damageP<A,, وvv

س ( membraneا@= ppglomerular fltration barrier ا

Dr ت .E0 ر يا JD ,,r&ف ا ل>P,, ف - ي !R ر DI<(* u ت فs @ ن Y5Proteinuria يو ,,segmentalأ

$egmentalل ي. ب glomerulus Nا E ت =y ع ا%&و# *)>DI تvvف

glomerulusvvس (glomerulus % Uا%& globalا

#,,$egmental<تف DI<(* ssegmental sclerosisu

In&ol&ing only some part o) the glomerulus

glomerulusا%& €sclerosis and hyalinosis&)- ي damage,, و

G=N5 نا - ي ل Y5Kproteinuria ي

ه JDProteinuriavvv&يDr ت 8 .E0 ر ت )rا ا r=?.r,, و ن و. ي ر



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P< ) س ocal and segmental(ا

[5 ه نocal(ايا ? ر ي ي inimal change and membranousvv+اوP<)ocalت 2 ي ا di,, و use

W5=%k( ج,,نق = نا - ي ل ,,KProteinuria@ ي Y يلP(\a2 ( 5- ن s)ocal and segmental Y5 uKnephrotic -' ع

syndrome

A ي Bا ,,)ocal segmental glomerulosclerosisP< Y افيchildren#و adultvvاف

Y يفي 8. ن ا•

ل inimal change GN+اpp % أ% تchildrenافي Y ال• membranous GNاpp % أ% تadultافي Y ال• يفي Y ا 8. ن pp)ocal and segmentalاW .H ت ن = ا.*ا Non proli)erati&eع

,,Non proli)erati&eا‚membraneا - ن @ € ر ‚,, - ن @ 0 ب ر cell numberا 0 ب

,, x\ ل cellsاع )>I< 56 ppا…ت * فProli)erati&e% ل ( ة

=N2 2 .,, Non proli)erati&eافأ2= ا q. ل @(

q= لا8و#2 ن نminimal change GN@= ا ل فY ,,Knephrotic ي ?B8 ا

q= ت 2 ن نmembranousا ي ا 0 ب L فY5 ,,KNephrotic لq= ت ن نocal segmental glomerulosclerosis(ا ل فY ,,Knephrotic ي

?B8 ا 0 ب L أا

و. ي ف minimal change(Nا ر ب ت )ppmembraney اembranous+ا pploss o) charges 28 ا r=?5 ات )ppmembraney اocal segmental glomerulosclerosis(ا r=?5W ا

)ocal

لا - ن = ا ,,P(%Proli)erati&e -)اه G %I(Dي ا vvو



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\(E ة

5vv @( لdiا useG6# s ,, N 5 ب U ي u@ ن }=proli)erati&e 6F% ل ( ف

• U ي embrano7proli)erati&e+ف• U ي ف esangio7proli)erati&e+و• U ي ف ‚rescentic GN%و U ي ? s ) ل %proli)erati&eW 2 ي ل

proli)eration 6 =N ت@ ن ل9 +> = ق uا• U ي ف i*و use proli)erati&e ,,ocal(ا


I(D%&ف ا ,,pathologyاN. ,, 5= >وو =N.نو ل Y 5` vv ي

و I(Dأ ا ,,و+embrano7proli)erati&e

ل5 ه yا ي@ ي Y ر vvفG6# =05 U ي cellsا -)>Proli)erationف

ل5 yا لvv 5@ ن@ ي Y ر JDvv&اP<ب %P<و ,, h. 6 ,,ل .ا ع ف membranous GNات 0 < ,,membrano7proli)erati&e ي U 5- ن embrane ,,proli)eration& cells+ف

ل6 .ا di,, { ب _ف use lea"y thic"ening o) the glomerular basementmembrane

0 ,,F '51 U ي ل ي2( رIع يIntracapillary proli)eration,, ا. ن . ن sاcells

uا (= ج =>5

يي 8. ن Intracapillary proli)erationvvvاف ا (= ج =>cells 5اndothelium ,,mesangial cellsل matrixuا@= s ا

ن )P<Pا - ي 5 ب N ى يع ت ,, }0 لة pplea"y thic"ening }0 لة ppintracapillary proli)erationو }0 ل



P a g e | 1=م ق ل س ه و ي ل ه ع ل ى ا ل " ص ب ن أ ا ة ج ا ذ و ر ت ن ا ذ% ر$ # ! ب ف س ف '& ا " أ

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A ي B,,ة نlea"y thic"ening %presentا }0 ل vv `5 ية ي * ج ,,ا. ن

• = se&ere << nephrotic syndrome • = mild << asymptomatic proteinuria

ة intracapillary proli)eration pprepresent 5` vvvا }0 ل(E5اcapillary lumen,,,,e ي capillary lumen N lا

ƒا glomerular fltration rateا%( يpp 5 ب e N ي capillary lumenlا% و&N ت @ ppk - ب B

ل 2 ل لYD ق ,,bloodاي E ت N ب &ا

ا5 ب N ى

glomerular fltration rate&N ي @ pp نا - ي 5 ب N ى ل Y5 5` vv ي

I ?J) اI<و(E I ?J) ا s ,,ل capillary lumenuا@ ا

2 U 5 س )5 ت` vv proli)erating endothelium#و Proli)erating mesangiumvvي 8. ن اG=N5اcapillary lumen N 5 ب ppl ي e e )E.1 ppnephritic syndrome ي 5l ب capillary lumen Nاو (

g5فppN2 5- نNephritic syndromeا ت J ر ن>Pا - ي 5 ب N ى '/Gا ل Y5$ ي•Knephrotic Nephriticأ•ى ي U يAEDل Predominantف

W ل \x ,,q= نP<smembrano7proli)erati&epp unephrotic or nephritic ‚و E ه 2(h #Nephrotic#و nephritic

0 @(\a ل9 +,, @ ن ا - ( يKLا

لا x ,,GH0\ ل ,,ن N= ا8ج Z ا+ع } ر%Z -‡فت )\&>ا % ل ( %&ف,, ف

ل2)\& اD). 2 ع Proli)erati&eافو+esangio7Proli)erati&e GN




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يL ق>esangio7proli)erati&eP+ا ,,ا. نG6# =05ي يs 5 ب Proli)erati&e N% ل ( ف numberuاف ت 0 تcellف

[esangio7proli)erati&e+ا لع5? ر rا ,,%)Pفف +ar"ed proli)eration o) the mesangial cells_N ف pp € endothelial cells

ن>Pا - ي ل Y5 5` vvv يncroachmentل capillary lumenا ع

ن ل Y5NephriticW ي

T? 5 ن Y5Knephroticvvv#يmembraneا8 ل pp س

ه esangio7proli)erati&evv+س (=@ يل@ esangial cells+اع } rا ر لJD ,,Proli)eration ل U % ب @ s ا

لatrix+ا connecti&e tissueuا@ ,, ا

P<اوPresentationي E ̂ر ي ي ا ,,ف Nephritic syndromeا

x =N5 5vvا…ت * فP(% Y5ع } *iscuss GN Presentation&0 pathologyا,, و%&pathologyا%&@ ت N= ه

6K= ف 0 تK ا 0 ت

G %ج D @ ق = ن Y ي ت *)Nephriticت vv> = قي $ا. ن•+embrano7proli)erati&e•+esangio7proli)erati&e

ي2 ق ت ج 5 ي%( D ج ل9 +,, ,,و@ ن U =N ا

x ,,%rescentic GN\ لP< ت Proli)erati&eا,, . ب Tا

x =N@يP=) س%rescentic GNت ل9 +> = ق ا

&J* يي . Proli)erationف ,,ل5 ه يا vvف




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ي extracapillary cells&JD Uا@ ن proli)erationف&JD rapid proli)erationو

'apidف H\<5- 5 أvv subacuteي 0= 5vvv- ن5 أ>\Hفي 0= 5- نsubacuteاق = ن

Dee"s to months

W ل \x N ,,q= نP< U k( اج ,,Proli)eration& extracapillary cell

&@ ) x = ق #endothelial cellsvvvا5 ن ?extra7capillaryTأT? ا5 نmesangial cellsvv#

و vvيأ• 5&isceral epithelium • 5parietal epithelium parietal epitheliumاي 0= ا *N ي N ف@=

ا ,, - Z%L 5 ون = ل ppProli)eration& parietal @ ي *8owman9s space&Jا>h.P ي

epitheliumل u\ رsP ا U ل J* ي @+ar"ed proli)eration

ا \)mar"ed proli)erationP< 5و ا crescentا09&ول P(% )E51crescentic in shapeu,, ع } @s =@H ا

Proli)eration& parietal epitheliumا,, ع } 1crescentic GNس ( Žي @ ل لepithelial cellsا@ s ا crescentuا9 ب@ ا

P<و&J*5ي uvvv يs 5' ي 5vvvl5( Ž 5l فl 8ا5' يowman9s space

ل8owman9s space(- ,, 5=9€h5ا5' ي lو ( يppencroachment 5-( لucapillary lumen اs 5)ف capillary ]Z5Tاع ل رP ع

س - capillaryا. ب fltration<€ ,,G6# Nا. ن Z ع } 2و@= ا وا ي8owman9s space,, و ل vv سI=5أ

2 N ) N ي e8اowman9s spaceN يŽ e capillaryا,, و




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ي &fltrationا5 ب N ى ل ل,, 5 ب N ق ي &2 6 ا ل ق

لPatientا5 ب N ى Y5rapidly progressi&e GN ي

'apidly progressi&e GN5- ن pprapidly progressi&e renal )ailure

ق ف 5vvvDee"s to months أ>و

q= نP<ل representK pprapidly progressi&e GNاي U (\a. ,,T ا )2 ي.' Žي essels<l&اsubacute(* s@= ل س أ

L=U9uر5I- ن ت ر5- ف ailureu( srapidly progressi&e renalج )kس

vvيJD ل renal )ailureاN2اG/' glomerular fltration rate 3,, ) N ا. نG/'N 5 ن ppاurineل س )5 ن>Pس )5 نع } N pprenal )ailure 2 6 ا لP< screscentو r ا uف =[ˆU ر

A ي BP< ,,Proli)erati&e#و € proli)erati&evvvProli)erati&e

تH.Proli)erati&e. ق = أ2 5 ب N ى ,,> = قو• I(Dأ ا اpp+embrane اmembrano7proli)erati&eو mesangial و

cellsا endothelium وI(Dو. 2 • ا ppmesangial cellsW اmesangioproli)erati&eوI(Dو. • ا اppepithelial اcrescenticو parietal epithelialW و

ن )5 ت ?'& ,,%)P -)ع*i use proli)erati&e

F={2y.- = ا يي Y ر 5vvv فو I(Dأ ا ppintra capillaryو

proli)eration vv ( ي& endothelium 0) ا,, و

mesangial cells ) h 5 تx 5 5-( لvvv

Narrowing o) the lumenq ت ا,, capillary

ف ,,ا = ق W?2و



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extra capillary proli)eration& epitheliumاف =[ل

W U2أepitheliumvv isceral epithelium&ا

J*5 5vv&. ت isceral epithelium h&ا ( Narrowing o) 8owman9s space

Ž eي Nج = lumenاŽ eي 52N ب N ى ر8owman9s space Iا,, و

ن ل '/Y5 ppKmar"ed decrease o) G يص G/'H k ? ي € I أ ?J) ا ,,r(E. uرPوج = s ا

8G( يي -)ا vvنرcapillaryIاج = ي -) s8owman9s spaceu &,, بfع } و Proximal con&oluted tubules &5 ر

) N ن وG/' Glomerular fltration rate 3اي و و pp أنا - ي ل H\days to wee"s فKnephritic syndrome@ ي Y ين ل رY5Kppacute renal )ailureT5 ي ج )k س

diا use proli)erati&eT5ر ج )ppk س#cute renal )ailureف ppH\G 5أT ي 8س

W5=%و و و diاأ use proli)erati&e Ehis is the most common pathology in nephritic syndrome

Post streptococcal GNافلا - ي Kpost streptococcal GNج ان )PathologyPا@ ت Hق س J *.K=0 ي = ع ppdiا ( ي 0 ر use

proli)erati&e س )5ج = س )5 رIو

ا - ي ل xو ع Y ي ppacute ج )E k ر

(Dا ل$ N5= و rا عي Y % ر>ف ,, E رل# r,, ا pp u أ ;screscentic GNaف rل H\wee"s toف س )parietalاs%rescentic GN % pp uف

months rapidly progressi&e@ ل

0 ,,diا use proli)erati&e,,



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H\days to wee"sي 0= *i use5- ن pp = وجPر

P(%T L8اq لأ2= ا ي U ا proli)erationفvvv `5 ي Proli)erati&e Yا -{ مKnephritic syndromeي Y= ا

vv `5 1جNon proli)erati&eا م 1KNephrotic syndromeج

proli)erati&e Y5 ppKnephriticا -{ م erati&e(membrano7proliع )

% 0) =05P - nephrotic syndrome ن )5 ت ?'& اq=2 2ع \ ر لأ @= ,, ا

Ig# nephropathy F8erger9s diseaseFP<)ocal,,

W T ن = ا. ب Proli)erati&eاع

N ,,P<the most common )orm o) GNل ا…HB[ ع

Ehis is the most common )orm GN

ر pathology& GN << commonأ% ت

Ig# nephropathyا@= &J* يantibodies q=2Ig#ج U ا,, ت-idney 5vv ت -(&

و ق &pp 5- نD)ocal جأ idney-ا• j~أ

In the )orm o) vvv€ sclerosis and hyalinosis ي% ل sclerosis and hyalinosis % pp)ocal segmentalفنو% ل Y5KNephrotic ي

#,,ي Ig# nephropathy Uا mesangial proli)eration,, ف

G6# =05 U ي proli)eration % ل ( ف

ي mesangial cells&J*5 Uا ( capillary lumenا,, @ ت ' Žي Proli)erationlفل G/'uاKnephriticN2 sا - ي Y5 ي




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,,ا = ق W?2فه glomerular in,ammation and necrosisيلantibodyا5- ن Ig#r@ ا glomerular basement membraneا,, %E ر

ل ( .E0 ا - ي ف ن )Pا ,,glomerular basement membraneاعه ل Y hematuria ي

ن>Pا - ي 5 ب N ى ل Y 5` vvv ي Y ني capillary lumenات ' ي Kmesangial proli)eration< pplي

G=N5 Y5nephriticN2 sاG/'u

ف ,,ا = ق W?2و,,ج = endotheliumا ت antibody E0ا ) E0 ا5 تendothelium5- ن ppnecrosis ) &J*5necrosis( ت G<ppHematuria. ن idney Z-اpp . ب

Ig# nephropathy ppاP<ا+ost common GN

A ي B,,ى ل glomerulus N vvا E ت =yع

aا05= ection << global or segmentalvvv

segmentalW ,,€ sclerosis and hyalinosisي 0= و ي U أ 5vvv ف

ب N ى ي U ي . ت - =DW L ت فesangial proli)eration 00 in,ammation+ف&J*5N2افG/'

ه G/'vvافN2ي8&JDmesangial proli)eration&?N ت ppاlumen

Ig# nephropathy ppا5 ب N ى/ocal and segmental W € sclerosis and hyalinosis 0 s U ي ,, mesangial proli)erationف

hematuriau

G %ج D U 5 ق = ت R ت GNvvvاي Y5 U (0 > = قNephrotic 00 nephritic 00 asymptomatic proteinuria 00 hematuria 00 renal )ailure




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P(%ق = ن ).r ج D&'? ن ),, 5 ت \ ع ,,D جأ%hronic GN

,,chronic glomerulonephritisا € T ي ( . ب EN ت ا

ه ت EN ي ( . ب T €ي vvاى ع Proli)erati&eا. ب U;*.T وو Non proli)erati&eاأ

chronic GNP< ppendا8stage&0 r ج ا * ,,@ ن. ي Y (0 5- ن

@ ن. ي Y و (0

ن )„ر Tفف (*;=B ة ي,, 5 ت P(D= Nع ل ع Ehe end stage o) other types o) GN

ل5 ه chronic GNvvvافي *J&الpp ي *chronic GN&Jا يy( L=U9ع E ن

يchronic(\a. pp L=U9,, . ت *= Pathologiesا N ي ( *) ن س و

,,chronic GNا

يت Hق يglomeruliا فatrophyف interstitial fbrosisو tubulesا فatrophy,, ف

P<و&J* يT اnd stage o) other types o) GN U2أother typesvvاProli)erati&evv#اوnon proli)erati&evvي 8. ن ا

ت *;€ EN.I(D ي ( . ب Tي ا و Ehere)ore0 it presents with chronic renal )ailure

(- L=U9ي ن س B=5 لو

(Dا ت )yو ن )Pا ,,embranous+ا (=q=eع (\ L=U9ي ن س ا2 ت U ا.*= * )و ن )Pا (=q=e,, و Kchronic renalع)ailure

z tubulesvvا و#glomerulusا ب =chronic renal )ailurezا يpp ي 8. ن ا

ا ن )interstitial tissuePو %)P ع



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nd stage renal disease,, أKchronic renal )ailureنY5 ف - ي =@ 5] chronic renal )ailure end stage renal diseasevvيا ? رend stage renal diseaseG6# pp =05chronic renal )ailureا,, %& J= اW 5 * تdialysis 5 ,,transplant

0 ,, dialysis * ت chronic renal )ailureا%& €ه ي 2 يي يع يchronic renal )ailure% ت 9 ي ,,conser&ati&e treatment

ر@ م ت *= = اG=5G 58ف E ي end stage renal disease@ ي

GN (pathology oافأ2= ا TE.q%)5P ب N ى discuss GN$@ ي x =Nا…ت * فا E‰ اA ت 0 ت&%GH0 اK= فا (0 تK وا 0 ت Fأ D \8F ر ق = ن DP ر

&e رDI جف وص R ي و و ,,أ,,clinical presentationا ,,ق = ن @ D ن

1B Nephrotic syndrome2B Nephritic syndrome #cute GN3(B @rinary abnormalities eBgB hematuria0 proteinuria.B #'/ o&er days to wee"s3

B 'apidly progressi&e '/ o&er wee"s to months 34B %'/ o&er months to years 3:B Hypertension

لي ي U % ا nephroticvvvفinimal change 00 +embranous 00 )ocal segmental 00 +embrano7+ا%

proli)erati&e

لي Knephriticvvي Y % ال ,,proli)erati&eا -{ acute GN % ,, uا@ s اdiاأ@(U م use proli)erati&e

,,Knephriticي Y % ل+embrano7proli)erati&e 00 mesangio7proli)erati&e 00 di use proli)erati&e 00 Ig#

nephropathy

لي Khematuriavvvي Y اي GN Uا,, %& x\ ل اD)أ% ت,, hematuriaW ف يو hematuriappفIg# nephropathy ا@=



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لي KProteinuriavvي Y ا&%r ج لا * Nephrotic syndromeت -(&اW 0) N ب .+ild asymptomatic

ي TأH\G 5 فacute renal )ailureا س ألي P(%vvع (&ا

*i use proli)erati&e

ي H\T فrapidly progressi&e renal )ailureا س }L=U ألي P(%vvع (&ا rescentic GN%ا

يH\ L=U9,, فchronic renal )ailureا ن س

\ ر hypertension,, اclinical presentationافD جأه و (renal disease 0ايhypertensionvvاي يpresentationأ

=05hypertension†vvx ل Y5H k S ‡5 ي Re ;Re_ر ,,ع ,, و idney-ا$ N.F=9= ه

enin' ي ; ل renal damageTا8

D ن ,,secondary hypertensionا>wL\)2 و % )eK ب س ppGN اsecondary hypertensionاأ

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Documents

1-Introduction to Nephrology, Glomerulonephritis (2)