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Glomerulo nephritis

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Glomerulo nephritis

  1. 1. GLOMERULO NEPHRITIS Dr. Muhammad Hussain Baloch Assistant Professor/ Head of Nephrology Department RMC & Allied Hospitals Rawalpindi
  2. 2. GLOMERULO NEPHRITIS     Implies an immune pathogenesis All glomerular diseases not caused by GN  D.D DN, Amyloidosis, HTN & Hereditary nephropathies (Alport’s synd.) 1O  clinical manifestations restricted to kidney  Part of multi system disease (SLE or vasculitis)
  3. 3. GLOMERULUS
  4. 4. GLOMERULUS Tuft of capillaries attached to mesangum enclosed in Bowmann’s capsule Filtration Barrier  Barrier is negatively charge 
  5. 5. CLASSIFICATION           Based on Histopathology Not IDEAL – One etiology may produce a variety of histologic patterns OR Various etiologies may produce similar pattern  L.M focal or diffuse - segmental or global  I.F or immunoperoxidase microscopy  E.M  morphology of basement membrane MCD FSGS Membranous Nephropathy MPGN Masangial proliferative GN Post infectious GN Crescentic G.N
  6. 6. ETIOLOGY  Idiopathic  Hereditary  INFECTIONS: Staph, Strept, E.Coli Leptospirosis, T.Pallidum, Coxiella, bmcella, listeria monocytogenes  Schistosoma, Trichinella, Spiralis  Hepatitis A,B,C, HIV, CMV, MUMPS, Influnsa, EBV and Echo  Histoplasma, candida  Plasmodum, Toxaplasma, trypanosoma  Multisystem disease  D.M  HTN  Amyloidosis  Vasculitis - ANCA Vasculitis  SLE  Malignancies
  7. 7. CLINICAL PRESENTATION 1. ASYMPTOMATIC PROTEINURIA  Proteinuria 150mg – 3 gram / day  Hematuria > 2 RBCs/HPF  FSGS Mesangial proliferative GN (IgA)
  8. 8. 2. NEPHROTIC SYND  Proteinuria > 3.5g/day or > 40mg/hour/m2  Hypoalbuminemia <3.5 g/dL  Edema  Hyperclolesterolemia  Lipiduria
  9. 9.         MCD Membranous GN MEMBRANOUS GN FSGS, Mesangioproliferative GN MPGN – I, MPGN II Diabetic glomerulosclerosis Amyloidosis LCDD
  10. 10. 3.Asymptomatic Microscopic Hematuria    T.B.M Nephropathy 1gA Nephropathy Alport’s Synd.
  11. 11. 4.RECURRENT GROSS HEMATURIA    TBM Nephropathy IgA Nephropathy Alport’s synd.
  12. 12. 5.ACUTE NEPHRITIC SYND  Oliguria  Hematuria  RBC casts  Proteinuria usually <3g/day  Edema  HTN   Acute diffuse Proliferative GN (Post staph and post strept) 6.FOCAL OR DIFFUSE PROLIFERRATIVE GN 1GA AND LUPUS NEPHRITIS
  13. 13. 7. RPGN  Renal Failure over day /weeks  Proteinuria usually < 3g/day  Hematuria RBC casts  BP often normal
  14. 14. CRESCENTIC GN  Anti GBM disease and syndrome     MPA W.G Goodpasture’s disease S.L.E  CSS HSP HUS BEHCEST’S DIS.  Essential Mixed cryoglobaulinemia  Rheumatoid vasculitis  Penicillamine therapy   Immue complex GN ANCA GN
  15. 15. 8.CHRONIC GN  Hypertension  Renal Insufficiency  Proteinuria > 3gram  Small shrunken Kidneys
  16. 16. DIAGNOSIS HISTORY        Symptoms – few & Late Urine DM. HTN, Amyloid, SLE, Vasculitis Family History – ALPORT’s HUS NSAID use Heroin Infections Malignancies  G.I – Membranous Hodgkin this –MCD Non Hodgkin MPGN
  17. 17. PHYSICAL EXAM Edema LAB  Urine  Serological tests         Anti dS DNA antibodies Cryogloblins RA Factor Anti GBM antibodies ANCA A.S.O titres Urine electrophoresis Serum complements level
  18. 18.   IMAGING USG RENAL BIOPSY
  19. 19. TREATMENT  B.P Control  Na+ restriction   Target 125/75 mm of Hg ACEIS & ARBs  Proteinuria    NSAIDS ? Protein restriction 0.8 – 1 g/day, Nephrectomy  Hyperlipidemia  Avoid nephrotoxic agents:    NSAIDS Radiocontrast Aminoglycosides
  20. 20.  Treat edema  Hypercoagulability heparin 5000 units s/c x BD    Management of infection S.B.P SPECIFIC THERAPIES

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