This 65-year-old man presents with nephrotic syndrome characterized by edema, hypoalbuminemia, and significant proteinuria. Laboratory tests show renal dysfunction. Kidney ultrasound reveals increased echogenicity. The most likely cause is focal segmental glomerulosclerosis, a common cause of nephrotic syndrome in adults.
Brief explanation of each *refer harrison textbook for details causes of TIN
Acute interstitial nephritis
Chronic interstitial nephritis
Reflux nephropathy
Papillary necrosis
Sickle-cell nephropathy
Dr Abdullah Ansari
MBBS, MD Medicine
Aligarh Muslim University
Clinical case
Hemolytic Anemia
Intravascular vs extravascular hemolysis
Classification of hemolytic anemia
Approach to hemolysis
Patient history
Clinical features
Peripheral blood smear
Investigation
Treatment
Brief explanation of each *refer harrison textbook for details causes of TIN
Acute interstitial nephritis
Chronic interstitial nephritis
Reflux nephropathy
Papillary necrosis
Sickle-cell nephropathy
Dr Abdullah Ansari
MBBS, MD Medicine
Aligarh Muslim University
Clinical case
Hemolytic Anemia
Intravascular vs extravascular hemolysis
Classification of hemolytic anemia
Approach to hemolysis
Patient history
Clinical features
Peripheral blood smear
Investigation
Treatment
A simplified description of ascitic fluid analysis. Aim of the presentation is to give a very clear understanding about the analysis of ascities.
Presentation will help the medical residents diagnose the cause of fluid accumulation in abdomen and thus will guide to adopt the appropriate pathway to solve the issue.
Systemic diseases associated with renal diseaseTONY SCARIA
diabetic nephropathy
leprosy
hepatitis c
hepatitis b
toxoplasmosis
mechanism of diabetic nephropathy
renal disease
medicine
pathology
last minute revision notes
high yield topic
hyaline arteriosclerosis
armanni ebstein cells
papillary necrosis
A simplified description of ascitic fluid analysis. Aim of the presentation is to give a very clear understanding about the analysis of ascities.
Presentation will help the medical residents diagnose the cause of fluid accumulation in abdomen and thus will guide to adopt the appropriate pathway to solve the issue.
Systemic diseases associated with renal diseaseTONY SCARIA
diabetic nephropathy
leprosy
hepatitis c
hepatitis b
toxoplasmosis
mechanism of diabetic nephropathy
renal disease
medicine
pathology
last minute revision notes
high yield topic
hyaline arteriosclerosis
armanni ebstein cells
papillary necrosis
Prof. Mridul Panditrao's Peri-operative Management of Jehovah's Witness Patient Prof. Mridul Panditrao
A case report of Emergency Peri-operative Mnagement of a Jehovah's Witness patient.
Because of their peculear religious belief, these patients do not accept Blood and It's products. This can pose serious problems to the Anesthesiologist.
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
263778731218 Abortion Clinic /Pills In Harare ,sisternakatoto
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TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
Acute scrotum is a general term referring to an emergency condition affecting the contents or the wall of the scrotum.
There are a number of conditions that present acutely, predominantly with pain and/or swelling
A careful and detailed history and examination, and in some cases, investigations allow differentiation between these diagnoses. A prompt diagnosis is essential as the patient may require urgent surgical intervention
Testicular torsion refers to twisting of the spermatic cord, causing ischaemia of the testicle.
Testicular torsion results from inadequate fixation of the testis to the tunica vaginalis producing ischemia from reduced arterial inflow and venous outflow obstruction.
The prevalence of testicular torsion in adult patients hospitalized with acute scrotal pain is approximately 25 to 50 percent
Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
5. Kidney diseasesKidney diseases
With respect to clinical features,With respect to clinical features,
pathogenesis, treatment and prognosispathogenesis, treatment and prognosis
they are distinct, by the componentthey are distinct, by the component
affectedaffected
Four basic componentsFour basic components::
1.1. GlomeruliGlomeruli
2.2. TubulesTubules
3.3. InterstitiumInterstitium
4.4. Blood vesselsBlood vessels
CSBRP-May-2014CSBRP-May-2014 55
6. Kidney diseasesKidney diseases
Four basic componentsFour basic components::
1.1. GlomeruliGlomeruli
2.2. TubulesTubules
3.3. InterstitiumInterstitium
4.4. Blood vesselsBlood vessels
Because of their interdependence (anatomical &Because of their interdependence (anatomical &
functional), in the course of time more than onefunctional), in the course of time more than one
structure may be affectedstructure may be affected
NoteNote: whatever the origin, in chronic kidney: whatever the origin, in chronic kidney
disease, all four components are destroyed–disease, all four components are destroyed–
ESKDESKD CSBRP-May-2014CSBRP-May-2014 66
7. Glomerular diseasesGlomerular diseases
Glomerulonephritis:Glomerulonephritis: Presence of InflammationPresence of Inflammation
Primary glomerular diseasePrimary glomerular disease
Kidney is the only predominant organ involved inKidney is the only predominant organ involved in
disease processdisease process
Secondary glomerular diseaseSecondary glomerular disease
Systemic disease affecting the glomerulusSystemic disease affecting the glomerulus
Glomerulopathy:Glomerulopathy: No inflammationNo inflammation
CSBRP-May-2014CSBRP-May-2014 77
19. MEMBRANOUSMEMBRANOUS
GLOMERULONEPHRITISGLOMERULONEPHRITIS
Drugs, Tumors, SLE, InfectionsDrugs, Tumors, SLE, Infections
Deposition of Ag-Ab complexesDeposition of Ag-Ab complexes
Indolent, but >60% persistent proteinuriaIndolent, but >60% persistent proteinuria
15% go on to nephrotic syndrome15% go on to nephrotic syndrome
20.
21. MINIMAL CHANGE GLOM.MINIMAL CHANGE GLOM.
(LIPOID NEPHROSIS)(LIPOID NEPHROSIS)
MOST COMMON CAUSE of NEPHROTICMOST COMMON CAUSE of NEPHROTIC
SYNDROME in CHILDRENSYNDROME in CHILDREN
EFFACEMENT of FOOT PROCESSESEFFACEMENT of FOOT PROCESSES
22. FOCAL SEGMENTAL
GLOMERULO-SCLEROSIS
Just like its nameJust like its name
FocalFocal
SegmentalSegmental
Glomerulo-SCLEROSIS (NOTGlomerulo-SCLEROSIS (NOT
–itis)–itis)
HIV, Heroine, Sickle Cell,HIV, Heroine, Sickle Cell,
ObesityObesity
Most common cause ofMost common cause of
ADULT nephrotic syndromeADULT nephrotic syndrome
23. MEMBRANOPROLIFERATIVEMEMBRANOPROLIFERATIVE
GLOMERULONEPHRITISGLOMERULONEPHRITIS
MPGN can be idiopathic orMPGN can be idiopathic or
22º to chronic immuneº to chronic immune
diseases Hep-C, alpha-1-diseases Hep-C, alpha-1-
antitrypsin, HIV,antitrypsin, HIV,
MalignanciesMalignancies
GBM alterations, subendo.GBM alterations, subendo.
Leukocyte infiltrationsLeukocyte infiltrations
Predominant MESANGIALPredominant MESANGIAL
involvementinvolvement
24. IgA NEPHROPATHYIgA NEPHROPATHY
(BERGER DISEASE)(BERGER DISEASE)
Mild hematuriaMild hematuria
Mild proteinuriaMild proteinuria
IgA deposits in mesangiumIgA deposits in mesangium
25. HEREDITARY HEMATURIAHEREDITARY HEMATURIA
SYNDROMESSYNDROMES
ALPORT SYNDROMEALPORT SYNDROME
Progressive Renal FailureProgressive Renal Failure
Nerve DeafnessNerve Deafness
VARIOUS eye disorderVARIOUS eye disorder
DEFECTIVE COLLAGEN TYPE IVDEFECTIVE COLLAGEN TYPE IV
THIN GBMTHIN GBM (Glomerular Basement(Glomerular Basement
Membrane) Disease, i.e., about HALF asMembrane) Disease, i.e., about HALF as
uniformly thin as it should beuniformly thin as it should be
26. CHRONICCHRONIC
GLOMERULONEPHRITISGLOMERULONEPHRITIS
Can result from just about ANY ofCan result from just about ANY of
the previously described acutethe previously described acute
onesones
THIN CORTEXTHIN CORTEX
HYALINIZED (fibrotic) GLOMERULIHYALINIZED (fibrotic) GLOMERULI
OFTEN SEEN IN DIALYSISOFTEN SEEN IN DIALYSIS
PATIENTSPATIENTS
29. CaseCase
A 65 year old man presents with severalA 65 year old man presents with several
months of lower extremity edemamonths of lower extremity edema
Past history is unremarkable. Not on anyPast history is unremarkable. Not on any
medicationmedication
Recent symptoms: Fatigue and someRecent symptoms: Fatigue and some
weight loss. Appetite remains good.weight loss. Appetite remains good.
BP is 150/100 mm Hg, pulse 92,BP is 150/100 mm Hg, pulse 92,
periorbital plaques, edema and guaiac +periorbital plaques, edema and guaiac +
CSBRP-May-2014CSBRP-May-2014 2929
32. CaseCase
Lab: Cr 1.4 mg/dL, Hg 8 g/dL, MCV 70,Lab: Cr 1.4 mg/dL, Hg 8 g/dL, MCV 70,
cholesterol 450 mg/dL, albumin 2.0 g/dLcholesterol 450 mg/dL, albumin 2.0 g/dL
UA: 4+ protein, no blood and blandUA: 4+ protein, no blood and bland
sediment.sediment.
24 hour urine: 6 g protein24 hour urine: 6 g protein
Ultrasound shows 11 cm kidneysUltrasound shows 11 cm kidneys
bilaterally with increased echogenicitybilaterally with increased echogenicity
CSBRP-May-2014CSBRP-May-2014 3232
33. CaseCase
The most likely cause of his nephroticThe most likely cause of his nephrotic
syndrome is?syndrome is?
Hypertensive nephrosclerosisHypertensive nephrosclerosis
Diabetic nephropathyDiabetic nephropathy
Focal segmental glomerulosclerosisFocal segmental glomerulosclerosis
Membranous nephropathyMembranous nephropathy
Membranoproliferative glomerulonephritisMembranoproliferative glomerulonephritis
CSBRP-May-2014CSBRP-May-2014 3333
40. Membranous NephropathyMembranous Nephropathy
Secondary causesSecondary causes
Malignancy, primarily solid tumorsMalignancy, primarily solid tumors
Class V lupus nephritisClass V lupus nephritis
Rheumatoid arthritisRheumatoid arthritis
Hepatitis B and CHepatitis B and C
Drugs (penicillamine, gold, NSAID’s, captopril)Drugs (penicillamine, gold, NSAID’s, captopril)
SyphilisSyphilis
CSBRP-May-2014CSBRP-May-2014 4040
41. CaseCase
The most likely cause of his nephroticThe most likely cause of his nephrotic
syndrome is?syndrome is?
Hypertensive nephrosclerosisHypertensive nephrosclerosis
Diabetic nephropathyDiabetic nephropathy
Focal segmental glomerulosclerosisFocal segmental glomerulosclerosis
Membranous nephropathyMembranous nephropathy
Membranoproliferative glomerulonephritisMembranoproliferative glomerulonephritis
CSBRP-May-2014CSBRP-May-2014 4141
42. CaseCase
A 33 year old male presents with rightA 33 year old male presents with right
flank pain and gross hematuriaflank pain and gross hematuria
Past history: 3-4 episodes of hematuriaPast history: 3-4 episodes of hematuria
per year, 6 hospitalizations for painper year, 6 hospitalizations for pain
control, multiple evaluations with nocontrol, multiple evaluations with no
diagnosisdiagnosis
CSBRP-May-2014CSBRP-May-2014 4242
43. CaseCase
Exam: BP 140/95 mm Hg, pulse 78,Exam: BP 140/95 mm Hg, pulse 78,
chest, abdomen, extremities are normal.chest, abdomen, extremities are normal.
He has no rash or arthritisHe has no rash or arthritis
Lab: Cr 1.1 mg/dL, Hg 14 g/dl, UA showsLab: Cr 1.1 mg/dL, Hg 14 g/dl, UA shows
numerous RBC’s, no casts. 24 hr urinenumerous RBC’s, no casts. 24 hr urine
protein is 1.5 g. Ultrasound is normalprotein is 1.5 g. Ultrasound is normal
CSBRP-May-2014CSBRP-May-2014 4343
45. CaseCase
What is his diagnosis?What is his diagnosis?
Lupus nephritisLupus nephritis
IgA NephropathyIgA Nephropathy
Membranous nephropathyMembranous nephropathy
Membranoproliferative glomerulonephritisMembranoproliferative glomerulonephritis
from hepatitis Cfrom hepatitis C
NephrolithiasisNephrolithiasis
CSBRP-May-2014CSBRP-May-2014 4545
46. Glomerular DiseaseGlomerular Disease
Accounts for 51% of ESRD in the USAccounts for 51% of ESRD in the US
38% diabetic nephropathy38% diabetic nephropathy
13% nondiabetic glomerular disease13% nondiabetic glomerular disease
Definition of glomerulonephritisDefinition of glomerulonephritis
Intraglomerular inflammationIntraglomerular inflammation
Cellular proliferationCellular proliferation
HematuriaHematuria
Excludes nonproliferative disordersExcludes nonproliferative disorders
CSBRP-May-2014CSBRP-May-2014 4646
47. GlomerulonephritisGlomerulonephritis
Refers to that variety of kidney disease inRefers to that variety of kidney disease in
which proliferation and inflammation of thewhich proliferation and inflammation of the
glomerulus is secondary to anglomerulus is secondary to an
immunologic mechanismimmunologic mechanism
Presentation of GN varies fromPresentation of GN varies from::
Microscopic asymptomatic hematuria orMicroscopic asymptomatic hematuria or
proteinuriaproteinuria
Acute nephritisAcute nephritis
Rapidly progressive nephritisRapidly progressive nephritis
CSBRP-May-2014CSBRP-May-2014 4747
58. IgA NephropathyIgA Nephropathy
Common cause of glomerulonephritisCommon cause of glomerulonephritis
Mesangioproliferative glomerulonephritisMesangioproliferative glomerulonephritis
Asians and CaucasiansAsians and Caucasians
Rare in African-AmericansRare in African-Americans
Age 20-30Age 20-30
Males > FemalesMales > Females
Pathogenesis – altered regulation of IgAPathogenesis – altered regulation of IgA
CSBRP-May-2014CSBRP-May-2014 5858
63. Poststreptococcal GlomerulonephritisPoststreptococcal Glomerulonephritis
Clinical presentationClinical presentation
Children 2-10 yearsChildren 2-10 years
Uncommon over age 40 (< 10%)Uncommon over age 40 (< 10%)
Symptoms develop 7 days to 12 weeks after theSymptoms develop 7 days to 12 weeks after the
infectioninfection
Low complement levels (CLow complement levels (C33 and CH50)and CH50)
Spontaneous recovery is the ruleSpontaneous recovery is the rule
Hematuria can persist 6 monthsHematuria can persist 6 months
Proteinuria, mild can persist yearsProteinuria, mild can persist years
CSBRP-May-2014CSBRP-May-2014 6363
64. Poststreptococcal GlomerulonephritisPoststreptococcal Glomerulonephritis
PathogenesisPathogenesis
Nephritogenic strains of streptococciNephritogenic strains of streptococci
Planted antigenPlanted antigen
Nephritis associated plasmin receptor (GAPDH)Nephritis associated plasmin receptor (GAPDH)
Zymogen (cationic protein-subepithelial deposits)Zymogen (cationic protein-subepithelial deposits)
Host immune response (ab/ag)Host immune response (ab/ag)
Alternative pathway of complement activationAlternative pathway of complement activation
IgG and CIgG and C33 found in glomerulifound in glomeruli
CSBRP-May-2014CSBRP-May-2014 6464
68. CaseCase
A 47 year old man presented with 3 weeks ofA 47 year old man presented with 3 weeks of
malaise, anorexia, weight loss, cough and darkmalaise, anorexia, weight loss, cough and dark
urineurine
Past history: mild asthma, nonsmokerPast history: mild asthma, nonsmoker
Exam: BP 145/70, lungs with diffuse rhonchi,Exam: BP 145/70, lungs with diffuse rhonchi,
heart, abdomen normal, no rash, 2+ edemaheart, abdomen normal, no rash, 2+ edema
Lab: Cr 6.3 mg/dL, UA 3+ blood and protein,Lab: Cr 6.3 mg/dL, UA 3+ blood and protein,
dysmorphic rbc’sdysmorphic rbc’s
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69. CaseCase
What is his diagnosis?What is his diagnosis?
Lupus nephritisLupus nephritis
IgA nephropathyIgA nephropathy
Poststreptococcal glomerulonephritisPoststreptococcal glomerulonephritis
Anti-GBM diseaseAnti-GBM disease
Focal segmental glomerulosclerosisFocal segmental glomerulosclerosis
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70. Rapidly Progressive GlomerulonephritisRapidly Progressive Glomerulonephritis
Clinical syndromeClinical syndrome
Glomerulonephritis (nephritic syndrome)Glomerulonephritis (nephritic syndrome)
Rapid decline in renal functionRapid decline in renal function
Rare – 2-4% of all glomerulonephritisRare – 2-4% of all glomerulonephritis
Pathologic hallmark – crescentsPathologic hallmark – crescents
Classified based on presence or absence ofClassified based on presence or absence of
immune complexesimmune complexes
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73. Anti-GBM DiseaseAnti-GBM Disease
Clinical presentation:Clinical presentation:
Bimodal age distribution (3Bimodal age distribution (3rdrd
and 6and 6thth
decades)decades)
60-70% present with pulmonary hemorrhage60-70% present with pulmonary hemorrhage
Systemic symptoms - malaise, fatigue,Systemic symptoms - malaise, fatigue,
anorexia, weight loss, arthralgias, myalgiasanorexia, weight loss, arthralgias, myalgias
CaucasiansCaucasians
Rare in African-AmericansRare in African-Americans
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74. Anti-GBM DiseaseAnti-GBM Disease
PathogenesisPathogenesis
Antibodies develop againstAntibodies develop against αα3 chain type IV3 chain type IV
collagen in GBMcollagen in GBM
Linear deposition of IgG along GBMLinear deposition of IgG along GBM
Antibodies detected by ELISAAntibodies detected by ELISA
ANCA found in ~30% of patientsANCA found in ~30% of patients
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75. Anti-GBM DiseaseAnti-GBM Disease
Outcome poor without therapyOutcome poor without therapy
TreatmentTreatment
Corticosteroids alone insufficientCorticosteroids alone insufficient
CyclophosphamideCyclophosphamide
Plasma exchange with albumin 14 daysPlasma exchange with albumin 14 days
Renal recovery rare if patients presentRenal recovery rare if patients present
needing dialysisneeding dialysis
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78. CaseCase
24 year old female presents with24 year old female presents with
hypertension and edema. Two weekshypertension and edema. Two weeks
prior she developed a cough, chest pain,prior she developed a cough, chest pain,
nasal congestion and pain in her right earnasal congestion and pain in her right ear
and received a course of amoxicillin. Oneand received a course of amoxicillin. One
week prior she noted a rash on her faceweek prior she noted a rash on her face
and chest and complained of some pain inand chest and complained of some pain in
her hands.her hands.
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79. CaseCase
Past history: unremarkablePast history: unremarkable
Exam: BP 180/126 mm Hg. She hasExam: BP 180/126 mm Hg. She has
periorbital edema, normal oropharynx.periorbital edema, normal oropharynx.
Heart, lungs and abdomen are normal.Heart, lungs and abdomen are normal.
She has lower extremity edema and anShe has lower extremity edema and an
erythematous maculopapular rash overerythematous maculopapular rash over
her chest.her chest.
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81. CaseCase
What is your diagnosis?What is your diagnosis?
Poststreptococcal glomerulonephritisPoststreptococcal glomerulonephritis
IgA nephropathyIgA nephropathy
Lupus nephritisLupus nephritis
Membranous nephropathyMembranous nephropathy
Wegener’s granulomatosisWegener’s granulomatosis
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82. Systemic Lupus ErythematosisSystemic Lupus Erythematosis
Complex multisystem autoimmuneComplex multisystem autoimmune
diseasedisease
11 criteria – 4 present for diagnosis11 criteria – 4 present for diagnosis
Kidney is most common organ involvedKidney is most common organ involved
(50-75%)(50-75%)
Females > MalesFemales > Males
African-Americans have higher rates ofAfrican-Americans have higher rates of
lupus nephritis and worse renal survivallupus nephritis and worse renal survival
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83. Lupus NephritisLupus Nephritis
Clinical spectrumClinical spectrum
Mild urinary abnormalitiesMild urinary abnormalities
Acute and chronic kidney failureAcute and chronic kidney failure
Usually develops within 3 yearsUsually develops within 3 years
Pathogenesis of renal involvementPathogenesis of renal involvement
Histone-DNA complex – planted antigenHistone-DNA complex – planted antigen
Anti-dsDNA antibodies eluted from nephritic kidneysAnti-dsDNA antibodies eluted from nephritic kidneys
WHO recognizes 6 classesWHO recognizes 6 classes
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84. Classification of Lupus NephritisClassification of Lupus Nephritis
Class IClass I “normal”“normal”
Class IIClass II variable mesangial hyper-variable mesangial hyper-
cellularity and immune depositscellularity and immune deposits
Class IIIClass III focal proliferativefocal proliferative
glomerulonephritisglomerulonephritis
Class IVClass IV diffuse proliferativediffuse proliferative
glomerulonephritisglomerulonephritis
Class VClass V membranous nephropathymembranous nephropathy
Class VIClass VI chronic glomerulosclerosischronic glomerulosclerosis
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88. Evaluation ofEvaluation of
GlomerulonephritisGlomerulonephritis
History and examHistory and exam
Urinalysis – blood, protein and dysmorphicUrinalysis – blood, protein and dysmorphic
rbc’s +/- rbc castsrbc’s +/- rbc casts
ComplementsComplements
Additional serology as dictated byAdditional serology as dictated by
presentationpresentation
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91. SummarySummary
Glomerular disease is an important causeGlomerular disease is an important cause
of CKD and ESRD.of CKD and ESRD.
Patients can present with a variety ofPatients can present with a variety of
clinical syndromes.clinical syndromes.
A good history, exam and certain lab testsA good history, exam and certain lab tests
in conjunction with renal biopsy can oftenin conjunction with renal biopsy can often
lead to a diagnosis.lead to a diagnosis.
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Editor's Notes
Arrows= 20nm Filtration slits with thin diaphragm
906
Even though there are MANY types of glomerulonephropathies, here are some of the common findings seen in many of them.
Here is the warzone of the glomerulopathies: 1) podocytes, 2) basement membrane, 3) endothelium
Why is the pic on the left classic for glomerulonephritis? Ans: Inflammatory cell infiltrates in the glomeruli
Recent studies have suggested that crescents are primarily of monocytic origin. They are signs that ANY glomerulonephritis may be severe or “rapidly progressing”, i.e., death within 3 months usually.
To make a long story short, the NEPHROTIC SYMDROME is usually a sign of a glomerulonephropathy.
What does indolent mean?
“Causing little or no pain; inactive or relatively benign”
The ability to recognize the BM as being rather uniform in thickness and density is so critically important
Once again, as in “chronic” pancreatitis, the main features of “chronic” are more a fibrosis (hyalinization), rather than lymph and macrophage infiltrates.