Presentation on theme: "This lecture was conducted during the Nephrology Unit Grand Ground by Medical Student under Nephrology Division under the supervision and administration."— Presentation transcript:
This lecture was conducted during the Nephrology Unit Grand Ground by Medical Student under Nephrology Division under the supervision and administration of Prof. Jamal Al Wakeel, Head of Nephrology Unit, Department of Medicine and Dr. Abdulkareem Al Suwaida, Nephrology Consultant. Nephrology Division is not responsible for the content of the presentation for it is intended for learning and /or education purpose only.
Glomerular disease includes glomerulonephritis, i.e. inflammation of the glomeruli and glomerulopathies when there is no evidence of inflammation. Glomerulonephritis is a subset of glomerulopathies
Immune complex disease Neutrophils: Protease GBM degradation O₂ free readicals cell damage AA metabolites ↓ GFR Complement- dependentComplement-leukocyte- mediated mechanism Activation of the complement pathway Recruitment of neutrophils and monocytes C₅- C₉ (MAC) Epithelial cell detachment. (+) epithelial & mesangial cells to secrete damaging chemical mediators. Upregulates TGF receptors on epithelial cells, excessive synthesis of extracellular matrix which leads to GBM thickening
Diffuse proliferative GN (PGN) proliferation of cells within the glomeruli, accompanied by leukocyte filtrate typical features of immune complex disease : - hypocomplimentemia - granular deposits of IgG & complement on GBM Implicated antigens seem to be endostreptosin and nephritis – plasmin- binding ptn
Abrupt onset of : glomerular haematuria (RBC casts or dysmorphic RBC). non-nephrotic range proteinuria ( < 2 g in 24 hrs). oedema ( periorbital, sacral ). hypertension. transient renal impairment (oliguria, uraemia).
Base line measurements: - ↑ Urea - ↑ Creatinine - Urinalysis (MSU) : a) Urine microscopy (red cell cast) b) proteinuria
Diagnostically useful tests : Culture (swab from throat or infected skin) Serum anti-streptolysin-O titre Hepatitis B surface antigen Hepatitis C antibody anti DNA, ANCA ↓C3,4 Renal biopsy
Nephrotic syndrome HTN AKI Volume overload Pulmonary edema Chronic glomerulonephritis and CKI
Post streptococcal GN - Has a GOOD prognosis. - Supportive measures until spontaneous recovery. - Control HTN. - Fluid balance. - Oliguric with fluid overload. - GN complicating SLE or systemic vasculitides : immunosuppression with prednisolone, cyclophosphamide or azathioprine/ MMF.