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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
http://www.nlm.nih.gov/medlineplus/ency/article/000501.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/003579.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/003579.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/003580.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/003580.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/003579.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/003579.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/000501.htm7/30/2019 Curs 01 Engleza Glomerular Syndromes
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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.
http://www.nlm.nih.gov/medlineplus/ency/article/003907.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/003579.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/003579.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/003579.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/003579.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/003579.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/003579.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/003579.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/003579.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/003579.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/003579.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/003579.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/003579.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/003579.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/003579.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/003579.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/003579.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/003579.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/003579.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/003579.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/003579.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/003579.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/003579.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/003579.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/003579.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/003907.htm7/30/2019 Curs 01 Engleza Glomerular Syndromes
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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
http://www.nlm.nih.gov/medlineplus/ency/article/003579.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/003579.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/003579.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/003746.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/003579.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/003744.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/003579.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/003535.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/003579.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/000435.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/003579.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/003579.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/003456.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/003579.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/003539.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/003579.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/003354.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/003579.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/003579.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/002223.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/003579.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/003579.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/003524.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/003579.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/003579.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/003579.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/003579.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/003524.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/003524.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/003524.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/003579.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/003579.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/003579.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/003579.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/002223.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/003579.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/003579.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/003579.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/003354.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/003579.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/003579.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/003539.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/003579.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/003579.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/003456.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/003579.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/003579.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/003579.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/000435.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/003579.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/003579.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/003535.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/003579.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/003579.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/003744.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/003579.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/003579.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/003579.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/003746.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/003746.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/003579.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/003579.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/003579.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/003579.htm7/30/2019 Curs 01 Engleza Glomerular Syndromes
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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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