Uploaded byDr. Roopam Jain
The KIDNEY - PATHOGENESIS OF GLOMERULAR DISEASES
The document discusses glomerular diseases, which involve the renal glomeruli. It describes the classification of glomerular diseases into primary and secondary types. The major clinical manifestations are proteinuria, hematuria, hypertension, and impaired renal function. Six major glomerular syndromes are discussed: acute nephritic syndrome, nephrotic syndrome, acute renal failure, chronic renal failure, asymptomatic proteinuria, and asymptomatic hematuria. The pathogenesis of glomerular injury is examined by exploring the roles of endothelial, mesangial, epithelial and parietal cells as well as the glomerular basement membrane. Immunological and non-immunological mechanisms are involved in glomerular disease pathogenesis.
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Overview of glomerular diseases, led by Dr. Roopam Jain, focusing on definition and classification.
Classification into primary and secondary glomerulonephritis; clinicopathologic features.
Main clinical features include proteinuria, hematuria, hypertension, and renal function disturbances.
Acute onset nephritic syndrome features: microscopic hematuria, proteinuria, hypertension, edema, oliguria.
Nephrotic syndrome features: massive proteinuria and complications like hypo-albuminaemia and hyperlipidaemia.
Comparison between acute nephritic and nephrotic syndromes focusing on their features and implications.
Acute renal failure characterized by rapid renal function decline; linked to glomerular diseases.
Chronic renal failure from glomerular diseases marked by significant proteinuria, hematuria, and hypertension.
Unexpected proteinuria risks pointing to renal issues, requiring further investigation for glomerulonephritis.
Asymptomatic hematuria common in younger patients; linked to various renal pathologies, including glomerular causes.
Examining injury mechanisms in glomerular cells: endothelial, mesangial, and epithelial cells.
Immunologic and non-immunologic mechanisms leading to glomerular disease, emphasizing antibody roles.
Diagram depicting ultrastructure of glomerular lobule and patterns of deposits in immune-complex diseases.
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The KIDNEY - PATHOGENESIS OF GLOMERULAR DISEASES
- 1. The KIDNEY -4 DR. ROOPAM JAIN PROFESSOR & HEAD, PATHOLOGY
- 2. GLOMERULAR DISEASES DEFINITION ANDCLASSIFICATION • Glomerulonephritis (GN) or Bright’s disease is the term used for diseases that primarily involve the renal glomeruli. • classify - 2 broad groups: • I. Primary glomerulonephritis in which the glomeruli are the predominant site of involvement. • II. Secondary glomerular diseases include certain systemic and hereditary diseases which secondarily affect the glomeruli
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- 5. GLOMERULAR DISEASES CLINICAL MANIFESTATIONS •The clinical presentation of glomerular disease is quite variable but in general four features— • proteinuria, • haematuria, • hypertension and • disturbed excretory function
- 6. GLOMERULAR DISEASES • Followingsix major glomerular syndromes are commonly found in different glomerular diseases: • Nephritic and nephrotic syndromes; • Acute and chronic renal failure; • Asymptomatic proteinuria and haematuria
- 7. I. ACUTE NEPHRITICSYNDROME • This is the acute onset of microscopic haematuria, mild proteinuria, hypertension, oedema and oliguria following an infective illness about 10 to 20 days earlier. • 1. Haematuria • 2. Proteinuria • 3. Hypertension • 4. Oedema • 5. Oliguria
- 8. I. ACUTE NEPHRITICSYNDROME
- 9. II. NEPHROTIC SYNDROME •Nephrotic syndrome is characterised by • massive proteinuria, • hypo-albuminaemia, • oedema, • hyperlipidaemia, • lipiduria • hypercoagulability.
- 10. CAUSES OF NEPHROTICSYNDROME
- 11. CAUSES OF NEPHROTICSYNDROME
- 12. Contrasting features ofacute nephritic & nephrotic syndrome
- 13. Contrasting features ofacute nephritic & nephrotic syndrome
- 14. III. ACUTE RENALFAILURE • As already described above, acute renal failure (ARF) is characterised by rapid decline in renal function. • ARF has many causes including glomerular disease, principally rapidly progressive GN and acute diff use proliferative GN
- 15. IV. CHRONIC RENALFAILURE • Glomerular causes of chronic renal failure (CRF) have already been described. • These cases have advanced renal impairment progressing over years and is detected by significant proteinuria, haematuria, hypertension and azotaemia. • Such patients generally have small contracted kidneys due to chronic glomerulo nephritis
- 16. V. ASYMPTOMATIC PROTEINURIA •Presence of proteinuria unexpectedly in a patient may be unrelated to renal disease (e.g. exercise-induced, extreme lordosis and orthostatic proteinuria), or may indicate an under lying mild glomerulonephritis. • Association of asymptomatic haematuria, hypertension or impaired renal function with asymptomatic proteinuria should raise strong suspicion of underlying glomerulonephritis.
- 17. VI. ASYMPTOMATIC HAEMATURIA •common in children and young adolescents • causes such as diseases of the glomerulus, renal interstitium, calyceal system, ureter, bladder, prostate, urethra, and under lying bleeding disorder, congenital abnormalities of the kidneys or neoplasia. • Glomerular haematuria is indicated by the presence of red blood cells, red cell casts and haemoglobin in the urine. • Glomerular haematuria is frequently associated with asymptomatic proteinuria.
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- 19. • The consequencesof injury at different sites within the glomerulus in various glomerular diseases can be assessed when compared with the normal physiologic role of the main cells involved i.e. • endothelial, • mesangial, • visceral epithelial, and • parietal epithelial cells as well as of the • GBM
- 20. Relationship of physiologicrole of glomerular components with consequences in glomerular injury.
- 21. Pathogenetic mechanisms in glomerulardiseases • Immunologic mechanisms - primarily antibody-mediated (immune- complex disease). • cell-mediated immune reactions in the form of delayed type hyper sensitivity can also cause glomerular injury in some conditions. • In addition, a few secondary mechanisms and some non-immuno logic mechanisms are involved in the pathogenesis of some forms of glomerular diseases in human beings
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- 24. Diagrammatic representation ofultrastructure of a portion of glomerular lobule. It shows three patterns of irregular or granular glomerular deposits in immune-complex disease.