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Understanding Glomerular Diseases: Nephritis Pathology, Etiology, & Clinical Presentations, Study notes of Clinical Medicine

An in-depth exploration of various aspects of glomerular diseases, including clinical presentations, pathology, etiology, and specific cases. Topics covered include nephritis, urine analysis, glomerular proliferation, immunologic injury, and etiology of glomerular diseases. The document also includes real-life patient cases and discussions on acute nephritic syndrome, post-streptococcal GN, serum complement levels, demographics of IgA nephropathy, and Henoch-Schönlein Purpura.

What you will learn

  • What is the etiology of primary glomerular disease?
  • What are the clinical presentations of nephritis?
  • What is the significance of serum complement levels in glomerulonephritis?
  • What is the pathology of glomerular proliferation?
  • What are the mechanisms of immunologic injury to the glomerulus?

Typology: Study notes

2021/2022

Uploaded on 09/27/2022

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GLOMERULONEPHRITIDES
Vivette D’Agati
Jai Radhakrishnan
Approach to Glomerular
Diseases: Clinical Presentation
Nephritis
Renal failure
Hypertension
Hematuria
At
Nephrotic Syndrome
Heavy Proteinuria
Low serum Albumin
Edema
Asymptomatic Urinary Abnormalities
A
cu
t
e
Chronic
Rapidly
Progressive
High serum lipids
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GLOMERULONEPHRITIDES

Vivette D’Agati Jai Radhakrishnan

Approach to Glomerular

Diseases: Clinical Presentation

Nephritis ƒ Renal failure ƒ Hypertension ƒ Hematuria A t

Nephrotic Syndrome ƒ Heavy Proteinuria ƒ Low serum Albumin ƒ Edema

Asymptomatic Urinary Abnormalities

  • Acute
  • Chronic
  • Rapidly Progressive

ƒ High serum lipids

Urine Analysis

ƒ Urinary RBC’s, sometimes deformed ƒ RBC Casts

ƒ Large amounts Albuminuria ( >3g/Day )

Approach to Glomerular

Diseases: Pathology

ƒ Proliferation or Sclerosis ƒ Distribution

Glomerular Proliferation

  1. Endocapillary

2 2. ExtracapillaryExtracapillary (crescentic)

Patterns of Glomerular Disease

  1. Focal Vs Diffuse

2 Segmental2. Segmental VsVs GlobalGlobal

Vulnerability of Glomerulus

to IC Injury

  1. 20 20-25% of cardiac output 2 % f di

  2. High glomerular capillary pressure

  3. Fenestrated endothelium

  4. Concentration (sieving effect)

Approach to Glomerular Disease:

Etiology

ƒƒ HistoryHistory ƒ Primary Glomerular ƒ Physical Exam ƒ Laboratory, Radiological tests

ƒ Primary Glomerular Disease

  • e.g. minimal change disease es s ƒ^ Secondary (Systemic) Disease
  • e.g. Lupus
  • 7 year old child
  • Several days of sore throat + low grade fever; he is given acetaminophen, and recovers uneventfully.
  • 2 2 wks later develops dark, coca-cola colored urine k l t d l d k l l d i and notes urinating less.
  • Exam: pedal edema and elevated blood pressure.
  • Labs:
    • Urine: rbc’s, rbc casts, 2+ prot.
    • Creatinine 2.4 mg/dl