Nephritis2008.

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

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

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]

[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

[object Object],[object Object],Immunofluorescence microscopy

Clinical manifestations Atypical cases Typical cases severe cases

[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

[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

[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

Nephritis2008.

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Nephritis2008.