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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.
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
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?
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
Nephrotic SyndromeNephrotic SyndromeNephrotic SyndromeNephrotic Syndrome
Nephrotic SyndromeNephrotic SyndromeNephrotic SyndromeNephrotic Syndrome
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.”
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
Nephrotic SyndromeNephrotic Syndrome
Minimal Change DiseaseMinimal Change DiseaseMinimal Change DiseaseMinimal Change Disease
FSGSFSGSFSGSFSGS
Membranous Membranous NephropathyNephropathyMembranous Membranous NephropathyNephropathy