Glomerulonephritis

Glomerulonephritis - PROF. M. O. AL-SOHAIBANI...

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Unformatted text preview: PROF. M. O. AL-SOHAIBANI Glomerulonephritis Glomerulonephritis Contents- Introduction- Pathogenesis- Antibody Mediated Injury - Membranous glomerulonephritis- IgA nephropathy- Membranoproliferative glomerulonephritis- Post infectious glomerulonephritis- Antiglomerular basement membrane disease- Cell Mediated Injury- Minimal Change Disease- Focal Segmental Glomerulosclerosis Glomerulonephritis Fluid retention and altered renal regulation of blood pressure Hypertension Loss of intravascular oncotic pressure Edema Reduced or absent urine production Obliguria or anuria Impaired filtration of nitrogmous wastes Azotemia Loss of capillary wall integrity Hematuria Altered permeability of capillary walls Proteinuria Mechanism Signs/Symptoms Glomerulonephritis ++++ + Crescentic glomerulonephritis ++++ + Acute post-infectious GN +++ ++ Membranoproliferative GN ++ +++ IgA nephropathy + ++++ Focal segmental glomerulosclerosis + ++++ Membranous glomerulonephritis- +++++ Minimal change disease Nephrotic syndrome Nephritic syndrome Glomerulonephritis Clinical Syndrome Nephrotic Syndrome: Proteinuria in excess of 3.5 grams in 24 hours, accompanied by edema, hypoalbuminemia, hyperlipidemia and lipiduria. Acute nephritis or the Nephritic syndrome: Haematuria, variable proteinuria, azotemia, and hypertension. Rapidly progressive glomerulonephritis: Haematuria, oliguria and acute renal failure. Pathogenesis Charge-Selective Filter The filtration of albumin, a negatively charged molecule, is restricted to a greater extent than is the filtration of neutral dextran of an equivalent size. Molecular charge in addition to size influences the filtration of macromolecules across the glomerular capillary wall. Charge selectivity derives from electrostatic interactions between fixed negatively charged components of the capillary wall and the macromolecule. Filtration of polycations (positively charged molecules) is enhanced. Endothelial cells and the lamina rara intema provide the primary functional barrier to circulating polyanions. Pathogenesis Charge-Selective Filter Loss of the fixed negative charge of the glomerular capillary wall results in enhanced filtration of circulating polyanions. With loss of charge discrimination in glomerulonephritis, the capillary wall becomes essentially size-selective only Glomerulonephritis Antibody Mediated Injury- Antibody mediated glomerular injury usually occurs by one of four basic mechanisms. - Antibodies may interact with: 1. Intrinsic components of the glomerular basement membrane. 2. Antigens on glomerular cells. 3. Exogenous antigens planted within the glomerulus. 4. Glomerular deposition of circulating immune complexes. Glomerulonephritis Antibody Mediated Injury- Most glomerulonephritides are antibody mediated and include:- Membranous glomerulonephritis....
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This note was uploaded on 09/13/2011 for the course ENG 101 taught by Professor Dr.hickenbottom during the Spring '10 term at West Liberty.

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Glomerulonephritis - PROF. M. O. AL-SOHAIBANI...

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