glomerulonephritis

1. Department of pediatrics
Department of pediatrics
GLOMERULONEPHRITIS IN
GLOMERULONEPHRITIS IN
CHIDREN
CHIDREN

2. DEFINITION OF
DEFINITION OF
GLOMERULONEPHRITIS
GLOMERULONEPHRITIS
Most important group of
generalized parenchimal
diseases of mainly autoimmune
origin which has similar:
Etiology and pathogenesis
Etiology and pathogenesis
Clinical features
Clinical features
Morphology (various histology
Morphology (various histology
patterns)
patterns)

3. MAJOR CLINICAL MANIFESTATIONS OF
MAJOR CLINICAL MANIFESTATIONS OF
GLOMERULONEPHRITIS
GLOMERULONEPHRITIS
Acute nephritic syndrome
Nephrotic syndrome
Persistent urinary abnormalities with few or no
symptoms
Chronic glomerulonephritis

4. Pathogenesis of glomerulonephritis

5. Sponsored
Medical Lecture Notes – All Subjects
USMLE Exam (America) – Practice

6. ETIOLOGY OF NEPHRITIC SYNDROME
ETIOLOGY OF NEPHRITIC SYNDROME
• Post infectious glomerunephritis
• Ig A-disease
• Henoch-Schon
lein purpura

7. Characteristics of acute nephritic
Characteristics of acute nephritic
syndrome
syndrome
Haematuria
Haematuria
Oliguria
Oliguria
Oedema
Oedema
 Hypertension
Hypertension
Reduced glomerular
Reduced glomerular
filtration rate (GFR)
filtration rate (GFR)
 Proteinuria
Proteinuria
Fluid overload
Fluid overload

8. Features of acute nephritic syndrome
Features of acute nephritic syndrome
Haematuria is usually macroscopic with pink or
brown urine (like coca-cola)
Oliguria may be overlooked or absent in milder
cases
Oedema is usually mild or is often just peri-orbital-
weight gain may be detected
Hypertension common and associated with raised
urea and creatinine
Proteinuria is variable but usually less than in the
nephrotic syndrome

9. MANAGEMENT ISSUES IN THE NEPHRITIC
MANAGEMENT ISSUES IN THE NEPHRITIC
SYNDROME
SYNDROME
Skin and throat swab
Strep serology
Evaluation of complement
Urea, creatinine, electrolytes, urinalysis
BP
Urine output and daily weight loss
 Fluid and diet management
Treatment of infections

10. COMLICATIONS OF NEPHRITIC SYNDROME
COMLICATIONS OF NEPHRITIC SYNDROME
Hypertensive encephalopathy
(seizures, coma)
Heart failures (pulmonary oedema)
Uraemia requiring hemodialysis

11. NEPHROTIC SYNDROME
NEPHROTIC SYNDROME
This is a group of signs and symptoms
seen in patients with heavy proteinuria
Clinical features:
Clinical features:
Oedema
Proteinuria >3,5 g/24 hrs (> 0,05 g/kg/24
hrs)
Serum albumen <30 g/l
Hyperlipidemia and hypercoagulable
state

12. Primary glomerular diseases causing
Primary glomerular diseases causing
the nephrotic syndrome
the nephrotic syndrome
o Minimal change disease
Minimal change disease
o Focal and segmental glomerulosclerosis
Focal and segmental glomerulosclerosis
o Membranous glomerulonephritis
Membranous glomerulonephritis
o Proliferative nephritis:
Proliferative nephritis:
o Membrano-proliferative
Membrano-proliferative
 Focal proliferative
Focal proliferative
 Diffuse proliferative
Diffuse proliferative
 Mesangial proliferative
Mesangial proliferative

13. Primary glomerular diseases causing
Primary glomerular diseases causing
the nephrotic syndrome (cont.)
the nephrotic syndrome (cont.)
Systemic diseases:
Diabetes mellitus
HIV/AIDS
SLE and other connective tissue disorders
Amyloidosis
Nephrotoxic states: NSAIDS, poisoning
Allergic diseases: bee sting, pollens
Circulatory effects: CHF, constrictive
pericarditis
Neoplastic: leukemia, solid tumors

14. Membranoproliferative
Membranoproliferative
glomerulonephritis Type I
glomerulonephritis Type I
Membranous
Membranous
glomerulonephritis
glomerulonephritis
Membranoproliferative
Membranoproliferative
glomerulonephritis Type II
glomerulonephritis Type II

15. Electron microscopy
Electron microscopy
of kidneys in
of kidneys in
glomerulonephritis
glomerulonephritis
X-ray of healthy kidneys,
ureters, bladder

16. MANAGEMENT OF PATIENTS WITH
MANAGEMENT OF PATIENTS WITH
NEPHROTIC SYNDROME
NEPHROTIC SYNDROME
Na+ <60 mmol/24 hrs
Water restriction
Diuretics (if no volume depleted)
Reduced protein diet (controversial!!!)
Treatment of infections
Prevention of thrombosis
Specific therapy: corticosteroids,
immunosupression
For minimal change disease: prednisone for
prednisone for
16 weeks or prednisone+cyclophosphamide!!!
16 weeks or prednisone+cyclophosphamide!!!

17. INDICATIONS FOR HEMODIALYSIS
INDICATIONS FOR HEMODIALYSIS
• Pericarditis or pleuritis (urgent indication)
• Progressive uremic encephalopathy or neuropathy,
with signs such as confusion, asterixis, myoclonus,
wrist or foot drop, or, in severe cases, seizures
(urgent indication)
• A clinically significant bleeding diathesis attributable
to uremia (urgent indication)
• Fluid overload refractory to diuretics
• Hypertension poorly responsive to antihypertensive
medications
• Persistent metabolic disturbances that are refractory
to medical therapy; these include hyperkalemia,
metabolic acidosis, hypercalcemia, hypocalcemia,
and hyperphosphatemia
• Persistent nausea and vomiting
• Evidence of malnutrition

18. Peritoneal dialysis
Peritoneal dialysis Hemodialysis
Hemodialysis