Presentation is loading. Please wait.

Presentation is loading. Please wait.

INTRODUCTION TO NEPHROLOGY Jeffrey J. Kaufhold, MD RID YOURSELF OF BOTHERSOME BRAIN TISSUE THE KAUFHOLD WAY !

Similar presentations


Presentation on theme: "INTRODUCTION TO NEPHROLOGY Jeffrey J. Kaufhold, MD RID YOURSELF OF BOTHERSOME BRAIN TISSUE THE KAUFHOLD WAY !"— Presentation transcript:

1 INTRODUCTION TO NEPHROLOGY Jeffrey J. Kaufhold, MD RID YOURSELF OF BOTHERSOME BRAIN TISSUE THE KAUFHOLD WAY !

2 DEFINITIONS l GFR - true function of the kidney best measured by Inulin, Nuc. Med l CREATININE CLEARANCE - measurement is difficult in inpatients l COCKCROFT EQUATION: (140 - age) X Kg wt Screat X 72

3 NEPHROLOGY SUMMARY l DEFINITIONS l STRUCTURE FUNCTION CORRELATION l SPECTRUM OF GLOMERULAR DISEASE l SIMPLE, EASY, COVERS 85% OF CASES l WE GET PAID FOR THE OTHER 15%

4 Hematuria T I G H T S

5 Hematuria TUMOR I G H T S

6 Hematuria TUMOR I NFECTION G H T S

7 Hematuria TUMOR I NFECTION G LOMERULONEPHRITIS H T S

8 Hematuria TUMOR I NFECTION G LOMERULONEPHRITIS H EMATOLOGIC T S

9 Hematuria TUMOR I NFECTION G LOMERULONEPHRITIS H EMATOLOGIC T RAUMA S

10 Hematuria TUMOR I NFECTION G LOMERULONEPHRITIS H EMATOLOGIC T RAUMA S TONE

11

12 HEMATURIA Glomerular Causes: IgA (Bergers) Mesangioproliferative GN Hereditary GNs, including Alports, Thin Basement Membrane Hallmark of Glomerular Disease is RBC cast

13

14

15

16 Class 2 - mild mesangial hypercellularity

17 Hereditary Nephritis AlportsNail -PatellaThin Basement Mem.

18 NEPHROLOGY DEFINITIONS l HEMATURIA - DIFFERENTIAL TIGHTS TUMOR, INFECTION GNs, HEMATOLOGIC TRAUMA AND STONE l PROTEINURIA - normal up to 150 mg/24 h made up of tubular protein (Tamm Horsfal) ABnormal = albumin, >150 mg

19 PROTEINURIA LESS THAN 300 mg - normal 300 to 1200think orthostatic or interstitial mgtalk to the patient OVER 3 GmConsider Biopsy

20 PROTEINURIA Glomerular Causes: Minimal Change Disease - 25 % Focal Segmental Glomerulo Sclerosis FSGS - 30 % Membranous - 30 %

21 PROTEINURIA Relative Frequency by Age.

22 Membranous GN Silver stain showing thickened basement membrane and spiking caused by subepithelial deposits in the membrane.

23 Minimal Change Disease Normal appearing Glomerulus. Normal appearing interstitium.

24 Minimal Change EM Foot processes are completely effaced (no longer discreet).

25 Focal Segmental Glomerular Sclerosis (FSGS) Segments of glom are preserved and segments are sclerosed (darker pink).

26 NEPHROLOGY DEFINITIONS l PROTEIN/CREATININE RATIO based on assumption of 1 Gm of creatinine excreted per 24 hours: l <0.2 = normal l >3.0 nephrotic

27 NEPHROLOGY IDIOPATHIC GN'S NEPHRITIC HEREDITARY IgA (BERGER'S) MESANGIO- PROLIF. ITIC/OTIC MEMBRANO- PROLIF. PSGN NEPHROTIC NIL FSGS MEMBRANOUS

28 Post Infectious GN Proliferative with lots of PMNs visible.

29 PSGN Electron Microscopy Subepithelial Humps

30 Membrano-proliferative GN Lupus nephritis Class IV

31 NEPHROLOGY SYSTEMIC DZ NEPHRITIC LUPUS CLASS II AND III CRYOGLOBULINS ITIC/OTIC PSGN LUPUS IV (DPGN) NEPHROTIC DM AMYLOID MYELOMA LUPUS V

32 NEPHROLOGY RPGN CLASS I ANTI-GBM CLASS 2 CIRCULATING IMMUNE COMPLEXES R/O INTERSTITIAL DISEASE CLASS 3 PAUCI- IMMUNE (VASCULITIS) CLASS 4 VASCULOPATHY

33 Rapidly Progressive GN Clinical Syndrome ARF HTN RBC Casts Mimicked by TIN TIN Tubulointerstitial Nephritis or Crescents with characteristic change on Immunoflurescence

34 RPGN light Microscopy Interstitial NephritisCrescent

35 RPGN Class I Linear Immunofluresence Due to Anti-GBM Antibody Goodpastures Syndrome

36 RPGN Class II Granular IF Immune Complex Deposition Due to SLE, MPGN, HSP, PSGN, Others

37 RPGN III: Vasculitis Crescent with Focal Necrotizing GN Pauci-immune. ANCA Positive. Seen in Wegeners Granulomatosis, Churg- Strauss, PolyArteritis Nodosa (PAN). Necrotizing area

38 RPGN IV: Vasculopathy Hyaline thrombi Endothelial cell swelling and vacuolization Seen in TTP/HUS, Preeclampsia, Malignant HTN

39 Old Definitions l ACUTE RENAL FAILURE - acute deterioration over hours to days of renal function l CHRONIC RENAL FAILURE - progressive loss of renal function over years l CHRONIC RENAL INSUFFICIENCY - A chronic, fixed loss of renal function due to a past insult.

40 New Terminology ARF - RIFLE criteria Risk low uop for 6 hours, creat up 1.5 to 2 times baseline Injury creat up 2 to 3 times baseline, low uop for 12 hours Failure Creat up > 3 times baseline or over 4, anuria Loss of Function Dialysis requiring for > 4 weeks ESRD Dialysis requiring for > 3 months

41 New Terminology Chronic Kidney Disease CKD Stage 1 Normal GFR with known disease Stage 2 GFR ml/min Stage 3 GFR Stage 4 GFR Stage 5 GFR Stage 6 GFR < 10, ESRD.

42 NEPHROLOGY DEFINITIONS l DEHYDRATION - STATE OF FREE WATER LOSS l VOLUME DEPLETION - STATE OF SALT AND WATER LOSS

43 DIALYSIS DEFINITIONS l HEMODIALYSIS l PERITONEAL DIALYSIS l CAVHD l DIALYSIS ACCESS, FISTULA please don't say shunt or graft l ULTRAFILTRATION - removal of water with dissolved solute dragged along for the ride.

44 TRANSPLANT DEFINITIONS l ALLOGRAFT l REJECTION l IMMUNOSUPPRESSION

45 CORRELATIONS STRUCTURE Endothelium GBM Epithelium Mesangium FUNCTION make vessel seive charge select. makes GBM PATH kawasaki's Alport's proteinuria Minimal Change Berger's

46 Glomerular Physiology Afferent. Art AT II constrict ACE-i dilate PG's NET dilate TGF NET constrict NSAID's constrict Aminophylline dilate Diltiazem dilate Filt Press maintained reduced increase parallels reduce increase reduced Efferent Art. constrict dilate no effect dilate

47 Glomerular Physiology Blood flow determinants AfferentEfferent Filtration Systemic PG's TGF Local

48 Renal Physiology Overview Distal Tubule Loop of Henle Collecting duct ADH + ADH - permeable to H2O impermeable solute exchange reabsorption filtration impermeable to H2O solute imperm. to Proximal Tubule

49 CORRELATIONS STRUCTURE Endothelium GBM Epithelium Mesangium FUNCTION make vessel seive charge select. makes GBM PATH kawasaki's Alport's proteinuria Minimal Change Berger's


Download ppt "INTRODUCTION TO NEPHROLOGY Jeffrey J. Kaufhold, MD RID YOURSELF OF BOTHERSOME BRAIN TISSUE THE KAUFHOLD WAY !"

Similar presentations


Ads by Google