clinical syndromes related to renal disease

17
Clinical syndromes related to renal disease

Upload: arabela-eddery

Post on 01-Jan-2016

38 views

Category:

Documents


2 download

DESCRIPTION

Clinical syndromes related to renal disease. Acute nephritis. Hematuria, proteinuria, hypertension. Nephrotic synd. Proteinuria > 3.5 g/day, hypoalbuminemia

TRANSCRIPT

Page 1: Clinical syndromes related to renal disease

Clinical syndromes related to renal disease

Page 2: Clinical syndromes related to renal disease

Tubular defects, Urinary infections, Nephrolithiasis, Obstruction, Tumors

UremiaChr renal failure

Oliguria / anuria, azotemia, (Anuria <100 ml; oliguria 100-400 ml)

Ac renal failure

Due to subtle glomerular abnormalitiesAsymptomatic hemat / proteinuria

Proteinuria > 3.5 g/day, hypoalbuminemia <2 g/dl, edema, hyperlipidemia, lipiduria

Nephrotic synd

Hematuria, proteinuria, hypertensionAcute nephritis

Clinical syndromes related to renal disease

Page 3: Clinical syndromes related to renal disease
Page 4: Clinical syndromes related to renal disease

Renal failure - Acute

Syndrome characterized by acute suppression of renal function with oliguria / anuria, azotemia.

Major causes are - Vascular obstruction, Severe glomerular

disease, Acute tubulo-interstitial nephritis, Severe

pyelonephritis with papillary necrosis, Urinary obstruction,

Acute tubular necrosis.

Page 5: Clinical syndromes related to renal disease

Renal failure - Acute

Pathogenesis..

• Failure of glomerular filtration due to hypo-perfusion

• Renal causes

• Post-renal causes

End result is a decrease of GFR

Page 6: Clinical syndromes related to renal disease

Renal failure - Chronic

End result of various renal diseases. Four stages:

• Diminished renal reserve: GFR > 50%. Asymptomatic but

susceptible

• Renal insufficiency: GFR 20-50%. Azotemia, anemia, hypertension, polyuria. Sudden stress ----- Uremia

• Renal failure: GFR < 20%. Edema, metabolic acidosis, hypocalcemia, uremia with systemic complications.

• End-stage renal disease: GFR < 5%. Terminal stage of uremia.

Page 7: Clinical syndromes related to renal disease

Pathogenesis of Glomerulonephritis

Page 8: Clinical syndromes related to renal disease

Pathogenesis of glomerulonephritis

Immune mechanisms underlie majority of the primary glomerulonephritis1. In situ immune complex deposition

a. Intrinsic (fixed) glomerular antigensAnti GBM, Heymann nephritis, membranous nephropathyb. Planted antigens (proteins, bacterial, viral)

2. Circulating immune complexes

Others: cytotoxic antibodies, chemical mediators, cell mediated injury, non-immune mechanisms.

Page 9: Clinical syndromes related to renal disease

Pathogenesis of glomerulonephritis

Intrinsic (fixed) glomerular antigens - Anti GBM

• Antibodies directed against non-collagenous domain of type IV collagen.

• Linear pattern of fluorescence for IgG

• Underlying cause in Goodpasture’s

syndrome

Page 10: Clinical syndromes related to renal disease

Pathogenesis of glomerulonephritis

Intrinsic (fixed) glomerular antigens

Heymann nephritis, membranous nephropathy

• Animal model - rats immunized with preparations of PCT brush border

developed antibodies. Manifested as membranous glomerulonephritis closely

resembling human MGN.

• Sub-epithelial granular deposits of immunoglobulin.

• Heymann antigen is a 30 kd protein located in pits on the basal surface of

podocyte.

• Nature of antigen in man is unknown

Page 11: Clinical syndromes related to renal disease

Pathogenesis of glomerulonephritis

Circulating immune complexes -

• Localize in glomeruli due to physicochemical and hemodynamic factors

• Evocative antigen may be endogenous (SLE) or exogenous (PSGN, malaria etc)

• Immune complexes lie in mesangium and sub-endothelial region of glomerulus or

in sub-epithelial region. Deposits are granular.

• Localization of complexes is dependant on:

- Molecular charge: Cationic particles pass through GBM

- Molecular size

Page 12: Clinical syndromes related to renal disease
Page 13: Clinical syndromes related to renal disease
Page 14: Clinical syndromes related to renal disease
Page 15: Clinical syndromes related to renal disease
Page 16: Clinical syndromes related to renal disease

Immunological studies in glomerulonephritis.

• Immunofuorescence on biopsy• Complement levels• Circulating antibodies (ANA, GBM, ANCA)

Page 17: Clinical syndromes related to renal disease

Pathogenesis of glomerulonephritis

Cell mediated glomerular injury:

By activated T cells, monocytes and macrophages

- Delayed hypersensitivity by ag specific T cells

- Direct action by cytotoxic T cells

- Cytokine mediation

Tubulointerstitial nephritis ? Pauci-immune crescentic nephritis Minimal change nephropathy Focal segmental glomerulosclerosis