II) Acute GNII) Acute GNII) Acute GNII) Acute GN

Definition (Hricik et al, 1998)Definition (Hricik et al, 1998)

• Syndrome characterized by the abrupt onset of macroscopic hematuria; oliguria; acute renal failure; manifested by a sudden decrease in GFR; and fluid retention, manifested by edema and hypertension.

Definition (Hricik et al, 1998)Definition (Hricik et al, 1998)

• Syndrome characterized by the abrupt onset of macroscopic hematuria; oliguria; acute renal failure; manifested by a sudden decrease in GFR; and fluid retention, manifested by edema and hypertension.

Acute GNAcute GNAcute GNAcute GN

• Classically post-streptococcal although other infectious etiologies possible

• Acute pharyngitis followed 10-14 d later by acute nephritis (sodium and water retention, hypertension, ‘smoky’ coloured urine, fall in GFR

• Usually associated with low complement• Treatment is supportive• Prognosis generally good with spontaneous

resolution

• Classically post-streptococcal although other infectious etiologies possible

• Acute pharyngitis followed 10-14 d later by acute nephritis (sodium and water retention, hypertension, ‘smoky’ coloured urine, fall in GFR

• Usually associated with low complement• Treatment is supportive• Prognosis generally good with spontaneous

resolution

III) Nephrotic SyndromeIII) Nephrotic SyndromeIII) Nephrotic SyndromeIII) Nephrotic Syndrome

CaseCase

• 79 year old man, history of ureteric stenosis requiring stenting 8 years ago

• New onset edema, HTN• 24 hour urine – 13 g protein, cholesterol 11,

creatinine 135• Diagnosis?

CaseCase

• 79 year old man, history of ureteric stenosis requiring stenting 8 years ago

• New onset edema, HTN• 24 hour urine – 13 g protein, cholesterol 11,

creatinine 135• Diagnosis?

ProteinuriaProteinuriaProteinuriaProteinuria

MechanismsMechanisms

• Damage to glomerular BM/visceral epithelium• Impaired reabsorption by tubular cells• Secretion of protein from tubular cells• Filtration of an abnormal protein that is small

MechanismsMechanisms

• Damage to glomerular BM/visceral epithelium• Impaired reabsorption by tubular cells• Secretion of protein from tubular cells• Filtration of an abnormal protein that is small

Nephrotic SyndromeNephrotic SyndromeNephrotic SyndromeNephrotic Syndrome

Nephrotic SyndromeNephrotic SyndromeNephrotic SyndromeNephrotic Syndrome

Nephrotic SyndromeNephrotic SyndromeNephrotic SyndromeNephrotic Syndrome

Definition (Screiner, 1971)Definition (Screiner, 1971)

• “A clinical entity having multiple causes and characterized by increased glomerular permeability manifested by massive proteinuriaproteinuria and lipiduria. There is a variable tendency towards edemaedema, hypoalbuminemiahypoalbuminemia and hyperlipidemiahyperlipidemia. Protein excretion rates are usually in excess of 3.5 g/day/1.73m2 body surface in the absence of a depressed GFR.”

Definition (Screiner, 1971)Definition (Screiner, 1971)

• “A clinical entity having multiple causes and characterized by increased glomerular permeability manifested by massive proteinuriaproteinuria and lipiduria. There is a variable tendency towards edemaedema, hypoalbuminemiahypoalbuminemia and hyperlipidemiahyperlipidemia. Protein excretion rates are usually in excess of 3.5 g/day/1.73m2 body surface in the absence of a depressed GFR.”

Nephrotic SyndromeNephrotic SyndromeNephrotic SyndromeNephrotic Syndrome

Differential DiagnosisDifferential Diagnosis

• Minimal change• FSGS• Membranous• MPGN• IgA• nodular – amyloidosis, DM, fibrillary

Differential DiagnosisDifferential Diagnosis

• Minimal change• FSGS• Membranous• MPGN• IgA• nodular – amyloidosis, DM, fibrillary

Nephrotic SyndromeNephrotic Syndrome

Minimal Change DiseaseMinimal Change DiseaseMinimal Change DiseaseMinimal Change Disease

FSGSFSGSFSGSFSGS

Membranous Membranous NephropathyNephropathyMembranous Membranous NephropathyNephropathy