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Glomerular Diseases  in Children Lecturer Xin Yue TIANJIN MEDICAL UNIVERSITY  PEDIATRIC DPT.  GENERAL HOSPITAL
Anatomic and Structural  Characteristics  of  Kidneys
 
 
 
 
 
 
 
The nephron and collecting duct 1. renal corpuscle 2. proximal convoluted tubule 3. proximal straight tubule 4. descending thin limb 5. ascending thin limb 6. distal straight tubule (thick ascending tubule) 7. macula densa 8. Distal convoluted tubule 9. Connecting tubule 10. Cortical collecting duct 11. Outer medullary collecting duct 12. inner medullary collecting duct
 
Glomerulus
AA  afferent arteriole   MD  macula densa EGM  extraglomerular mesangium EA  efferent arteriole GC  granular cells SMC  vascular smooth muscle cells PE  parietal epithelium PO  podocyte M  mesangium   E  endothelium F  foot process GBM  glomerular basement  membrane US  urinary space
 
 
Glomerulus
Functions of  Kidneys ,[object Object],[object Object],[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Classification of  Glomerular Diseases Clinical  classification
Glomerulonephritis(GN) ,[object Object],[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Pathologic classification of primary GD
Acute  glomerulonephritis (AGN)
Introduction ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Introduction ,[object Object],[object Object],[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object],Epidemiology
Etiology ,[object Object],[object Object],[object Object],[object Object]
The difference of various APSGN ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Tonsillitis
[object Object],[object Object],[object Object],Pathogenesis
Traditionally,  streptococcal antigens  have  been considered to be the exogenous antigen stimulating  antigen-antibody circulating immune complexes  that are subsequently deposited along  the glomerular basement membrane  (GBM).  The processes of immunologic injuries on the GBM are as follows   : circulating immune complexes formation
Streptococcal infection immune complex formation immune injuries cellular proliferation  GBM fracture capillary lumen narrowed  hematuria glomerular blood flow decreased  proteinuria oliguria  GFR    azotemia    retention of water & sodium   blood volume     edema  hypertension edema hypertension hematuria proteinuria
[object Object],[object Object],[object Object],in situ immune complexes formation
Auto immune complexes formation ,[object Object]
[object Object],[object Object],Pathology
[object Object],generalized  -  diffuse
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],By light microscopy
 
 
 
[object Object],[object Object],By electron microscopy
 
 
Electron-dense deposits
Electron-dense deposits
[object Object],[object Object],Immunofluorescence microscopy
 
 
 
Clinical manifestations Atypical  cases Typical cases severe  cases
Typical  manifestations
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Edema and oliguria
 
 
[object Object],[object Object],[object Object],[object Object],[object Object],oliguria   anuria
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Hematuria
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Hypertension
[object Object],[object Object],Others
[object Object],[object Object],[object Object],Hypertensive  encephalopathy Circulatory congestion Severe  manifestations ,[object Object],[object Object]
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Circulatory congestion
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Hypertensive encephalopathy
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Acute renal failure
Atypical  manifestations
[object Object],[object Object],[object Object],[object Object],Asymptomatic acute nephritis The prodromes of  streptococcal infection and low level of  C 3  is helpful in diagnosis. Acute nephritis with minimal urinary findings Acute nephritis with severe proteinuria
Laboratory findings ,[object Object],[object Object],[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object],[object Object],Urinalysis
 
Red blood cell cast in a patient with glomerular hematuria
Granular cast
 
 
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Blood routine test and ESR
[object Object],[object Object],[object Object],[object Object],[object Object],Serum concentration of  complement  C 3
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Evidences of a prior  streptococcal infection
[object Object],[object Object],[object Object],[object Object],Renal function
Diagnosis ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Differential diagnosis ,[object Object],[object Object],[object Object],[object Object]
Treatment ,[object Object],[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object],Nursing and diet
[object Object],[object Object],[object Object],Antibiotic therapy
[object Object],[object Object],[object Object],[object Object],Symptomatic therapy
[object Object],[object Object],[object Object],[object Object],Diuretics
[object Object],[object Object],[object Object],[object Object],Antihypertensives
Treatment  of  severe complications
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Hypertensive encephalopathy
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Severe circulatory congestion
[object Object],[object Object],[object Object],[object Object],Acute renal failure
Disease course and prognosis (1) ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],(2)
Keys to be remembered ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
[object Object],[object Object],quiz

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Nephritis2008.

  • 1. Glomerular Diseases in Children Lecturer Xin Yue TIANJIN MEDICAL UNIVERSITY PEDIATRIC DPT. GENERAL HOSPITAL
  • 2. Anatomic and Structural Characteristics of Kidneys
  • 3.  
  • 4.  
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  • 6.  
  • 7.  
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  • 9.  
  • 10. The nephron and collecting duct 1. renal corpuscle 2. proximal convoluted tubule 3. proximal straight tubule 4. descending thin limb 5. ascending thin limb 6. distal straight tubule (thick ascending tubule) 7. macula densa 8. Distal convoluted tubule 9. Connecting tubule 10. Cortical collecting duct 11. Outer medullary collecting duct 12. inner medullary collecting duct
  • 11.  
  • 13. AA afferent arteriole MD macula densa EGM extraglomerular mesangium EA efferent arteriole GC granular cells SMC vascular smooth muscle cells PE parietal epithelium PO podocyte M mesangium E endothelium F foot process GBM glomerular basement membrane US urinary space
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  • 29. Traditionally, streptococcal antigens have been considered to be the exogenous antigen stimulating antigen-antibody circulating immune complexes that are subsequently deposited along the glomerular basement membrane (GBM). The processes of immunologic injuries on the GBM are as follows : circulating immune complexes formation
  • 30. Streptococcal infection immune complex formation immune injuries cellular proliferation GBM fracture capillary lumen narrowed hematuria glomerular blood flow decreased proteinuria oliguria GFR  azotemia retention of water & sodium blood volume  edema hypertension edema hypertension hematuria proteinuria
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  • 48. Clinical manifestations Atypical cases Typical cases severe cases
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  • 66. Red blood cell cast in a patient with glomerular hematuria
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  • 82. Treatment of severe complications
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