Hematuria, Proteinuria, Cylindruria
As few as three to five red blood cells Patients with glomerular disease usually
Poststreptococcal
Glomerulonephritis
Most commonly affects children 2 to 14 years of
age and is associated with debilitating conditions
in the elderly. And more often it is given to men.
Before glomerulopathy, the patient suffers
from skin and pharyngeal infections with
streptococcus.
The classic presentation is an acute nephritic picture
with hematuria, pyuria, red blood cell casts, edema,
hypertension, and oliguric renal failure, which may be
severe enough to appear as RPGN.
The classic presentation is an acute nephritic picture
with hematuria, pyuria, red blood cell casts, edema,
hypertension, and oliguric renal failure, which may be
severe enough to appear as RPGN.
Systemic symptoms of headache, malaise,
anorexia and flank pain (due to inflammation of
the renal capsule) are reported in up to 50% of
cases.
The diagnosis of post streptococcal glomerulonephritis
rarely requires a kidney biopsy, the subclinical disease is
reported in some series of four to five times as common
as clinical nephritis, and these latter cases are
characterized by asymptomatic microscopic hematuria
with low serum levels of complement C3.
Treatment is supportive, with control of hypertension,
edema, and dialysis as needed. Antibiotic Treatment for
Strep Infection It should be administered to all patients
and their cohabitants.
Sustained proteinuria >1?2 g/24 h is also commonly Fever, exercise, obesity, sleep apnea,
have some hematuria with varying degrees associated with glomerular disease. Patients often
in the spun sediment from first-voided will not know they have proteinuria unless they emotional stress, and congestive heart
of proteinuria. Hematuria is typically failure can explain transient proteinuria.
morning urine is suspicious. become edematous or notice foaming urine on
asymptomatic. voiding
Clinical Syndromes
Nephritic syndrome Nephrotic syndrome
Producing 1?2 g/24 h of proteinuria, Describes the onset of heavy proteinuria
hematuria with red blood cell casts, pyuria, (>3.0 g/24 h), hypertension,
hypertension, fluid retention, and a rise in hypercholesterolemia, hypoalbuminemia,
serum creatinine associated with a reduction edema/anasarca, and microscopic hematuria
in glomerular filtration.
Subacute Bacterial Lupus Nephritis Minimal Change Diabetic
endocarditis Disease Nephropathy
It presents as a primary renal disease, but
Is typically a complication of subacute bacterial Is a common and serious complication of may be associated with various other
endocarditis, particularly in patients who remain systemic lupus erythematosus and most severe
untreated for a long time, have negative blood cultures, conditions, on renal biopsy it does not Is the single most common cause of
in African-American female adolescents chronic renal failure, accounting for 45%
or have right-sided endocarditis. show obvious glomerular injury by light
microscopy and is negative for deposits by of patients receiving renal replacement
immunofluorescent microscopy, or therapy, and is a rapidly growing problem
occasionally shows small amounts of IgM worldwide.
Grossly, the kidneys in subacute bacterial Results from the deposition of circulating
immune complexes, which activate the in the mesangium.
endocarditis have subcapsular hemorrhages
with a ?flea-bitten?appearance complement cascade leading to
complement-mediated damage, leukocyte Risk factors for the development of
infiltration, activation of procoagulant factors,
diabetic nephropathy include
and release of various cytokines. Electron microscopy, consistently demonstrates hyperglycemia, hypertension,
The microscopy on renal biopsy reveals focal an effacement of the foot process that supports dyslipidemia, smoking, a family history of
proliferation around foci of necrosis associated with epithelial podocytes with weakening of the
abundant mesangial, subendothelial, and subepithelial diabetic nephropathy, and gene
cleft-pore membranes.
immune deposits of IgG, IgM, and C3 . Clinical polymorphisms affecting the activity of the
Manifestations renin-angiotensin-aldosterone axis.
Patients who present with a clinical picture Minimal change disease presents clinically with
the abrupt onset of edema and nephrotic
of RPGN have crescents. Embolic infarcts The most common clinical sign of renal disease is
Within 1?2 years after the onset
or septic abscesses may also be present. proteinuria, but hematuria, hypertension, varying syndrome accompanied by acellular urine
degrees of renal failure, and active urine sediment with sediment. of clinical diabetes, morphologic
red blood cell casts can all be present.
changes appear in the kidney.
Patients present with gross or microscopic hematuria,
pyuria, and mild proteinuria or, less commonly, RPGN The extrarenal manifestations of lupus are important in
with rapid loss of renal function. establishing a firm diagnosis of systemic lupus because, Relapses are frecuents of children after
Thickening of the GBM is a sensitive
while serologic abnormalities are common in lupus the first remission, and decrease after
nephritis, they are not diagnostic. indicator for the presence of diabetes but
puberty. Relapses are less common in
correlates poorly with the presence or
adults .
absence of clinically significant
A normocytic anemia, elevated erythrocyte
nephropathy
sedimentation rate, hypocomplementemia, high titers of
Anti-dsDNA antibodies that fix
rheumatoid factor, type III cryoglobulins, and circulating
immune complexes are often present. complement correlate best with the
presence of renal disease. Prednisone is first-line therapy, either
The composition of the GBM is
given daily or on alternate days. Other
immunosuppressive drugs are saved for altered notably with a loss of heparan
Primary treatment is eradication of the infection with 4?6
weeks of antibiotics, and if accomplished expeditiously, Hypocomplementemia is common in patients with acute
frequent relapsers, steroid-dependent, or sulfate moieties that form the
the prognosis for renal recovery is good. lupus nephritis and renal biopsy is the only reliable steroid-resistant patients. negatively charged filtration barrier
method of identifying the morphologic variants of lupus
nephritis.
In patients with types 1 or 2
Classification diabetes, microalbuminuria
appears 5?10 years after the
onset of diabetes
The lesions seen on biopsy provide
valuable prognostic information and forms
the basis for treatment recommendations.
Describes normal glomerular histology
Class I with minimal mesangial deposits
Designates mesangial immune
Class II complexes with mesangial proliferation.
Describes focal lesions with proliferation or
Class III scarring, often involving only a segment of the
glomerulus
Describes global, diffuse proliferative lesions
Class IV involving the vast majority of glomeruli
Describes subepithelial immune deposits
Class V producing a membranous pattern
Have greater than 90% sclerotic glomeruli and
Class VI end-stage renal disease with interstitial fibrosis
Systemic lupus tends to become quiescent once
there is renal failure, perhaps due to the
immunosuppressant effects of uremia.
Renal transplantation in renal failure from lupus, usually
performed after approximately 6 months of inactive
disease, results in allograft survival rates comparable to
patients transplanted for other reasons.