DrHazemKAlKhafaji MBCHBDMFICMS The clinical presentation of renal diseases include 1 Nephritic syndrome 2Nephrotic syndrome 3 Acute kidney injuryAKIthe old name acute renal failure ID: 784556
Download The PPT/PDF document "Lecture – 3 – Major renal syndromes" is the property of its rightful owner. Permission is granted to download and print the materials on this web site for personal, non-commercial use only, and to display it on your personal computer provided you do not modify the materials and that you retain all copyright notices contained in the materials. By downloading content from our website, you accept the terms of this agreement.
Slide1
Lecture – 3 –
Major renal syndromes
Dr.Hazem.K.Al-Khafaji
MBCHB.D.M.FICMS
Slide2The clinical presentation of renal diseases include:-
1- Nephritic syndrome
2-Nephrotic syndrome
3- Acute kidney injury(AKI),the old name acute renal failure.
3- Chronic kidney disease, previously chronic renal insufficiency ̸ failure.
4- Tubulointerstitial nephritis ̸ defects.
5- Urinary tract infection.
6-
Urolithiasis
.
7-
Renovascular
hypertension.
Slide3Inflammation of the
glomeruli
, this allow passage of protein& red blood cells in the urine with reduction in amount of urine. If left un treated can leads to scarring & irreversible loss of renal function(Chronic GN).affecting all ages but it is more common in children & young adults. classified according to histopathological findings.e.g focal,diffused.segmental & crescentic (crescent means accomulation of large pale cells within the Bowman”s capsule forming semicircular structure & this indicate the worst prognosis.The disease may be primary ( mostly due to immunological injury ) or may be secondary ; associated with other diseases as SLE , hepatitis , malaria & others.Treatment is aimed to decreaseing the inflammation,corticosteroids is the primary agents in most cases, other drugs ;Mycophenolate mofetil( cell cept ),cyclosporine, azothioprime.Glomerulopathy : the term used when there is no features of inflammation as in morbid obesity, Drugs,& HIV infection
Glomerulonephritis
Slide4Nephritic syndrome
Presence of glomerular disease mostly due to immunological injury. Characterestic features:-
Haematuria (especially dysmorphic red cells)Active sediments in the urine as red cell casts& ̸ or dysmorphic RBCs.Oliguria.Hypertension.Oedema.Proteinuria ( in the range of >3.5 g/24hours).Impaired renal function; raised b.urea & creatinine
Slide5Slide6Nephrotic
syndrome
متلازمة التناﺫر الكلويDefinition of Nephrotic Syndrome (NS) · NS is characterized by heavy proteinuria, hypoproteinemia, generalized edema and hyperlipidemia.Heavy proteinuria- when urinary protein excretion more than 40mg/m2/hour or 1g/m2/24hours. Or ≥3.5gm/day Hypoproteinemia- serum albumin < 3g/dl (adult) or 2.5g/dl(children).Hyperlipidemia-serum cholesterol>250mg/dl.BP may be normal ,decreased or increased.Other consequences are hypercoaguable state & depressed immunity.
Slide7Slide815 times more common in children than adults
Slide9The underlying primary defect is increased in the permeability.
The cause of the increased permeability is not well understood. In minimal change disease, it is possible that T-cell dysfunction leads to alteration of cytokines, which causes a loss of negatively charged
glycoproteins within the glomerular capillary wall.
Slide10Can be due to systemic(secondary) or
local renal disease(primary)
Diabetic nephropathy most common causeOther common causes include minimal change disease, focal segmental glomerulosclerosis, membranous nephropathy, membranoproliferative glomerulonephritis,Amyloidosis often secondary to multiple myeloma), light chain deposition disease.Nephrotic syndrome
Slide11Blood plasma v Filtrate
Component
Plasma / mg 100cm-3
Filtrate
/ mg 100cm
-3
Urea
0.03
0.03
Glucose
0.10
0.10
Amino acids
0.05
0.05
Salts
0.72
0.72
Proteins
8.00
0
Slide12Urine Dip
Protein +++
Slide13Slide14Slide15Slide16Acute kidney injury
previously known as acute renal failure, encompasses a wide spectrum of
injury to the kidneys, not just kidney failure. The definition of acute kidney injury has changed inrecent years, and detection is now mostly based on monitoring creatinine levels, with or withouturine output. Acute kidney injury is increasingly being seen in primary care in people without anyacute illness,
Slide17AKI (Acute Kidney Injury)
Definition and diagnostic Criteria
An abrupt (within 48hr) reduction in kidney function currently defined as an absolute increase in serum creatinine of either >0.3 mg/dL( over the baseline) or a percentage increase of >50% or a reduction in UOP (documented as oliguria of <0.5 ml/kg/hr for >6hr)
Slide18Acute kidney injury is seen in 13–18% of all people admitted to hospital
Slide19Acute Versus Chronic
Acute
sudden onsetrapid reduction in urine output( days – weeks )Usually reversibleTubular cell death and regenerationChronic Progressive( 3 months & more )Not reversibleNephron loss50% of function can be lost before its noticeable
Slide20Acute kidney injury/Acute
Renal Failure
Causes:-Pre-renal = 55%Renal parenchymal (intrinsic)= 40%Post-renal = 5-15%
Slide21Chronic renal failure
Chronic renal failure(Chronic kidney disease)
Progressive & irreversible renal loss (structural or functional) ≥ 3 months.
Slide221-kidney damage for ≥ 3months , as defined by structural or functional abnormalities of kidney, with or without decreased GFR,manifest
by either:
prolonged abnormalities; orMarkers of kidney damage including abnormalities in composition of the blood or urine, or abnormalities in imaging test. Or2- GFR ˂ 60ml ̸ min ̸ 1.73 m2 within ≥ 3 months with or without structural renal damageDefinition of chronic kidney diseaseCriteria
Slide23GFR ˂ 60ml ̸ min ̸ 1.73
m
2 within ≥ 3 months with or without structural renal damage
Slide24Chronic Renal Failure
A. Definitions
Azotemia - elevated blood urea nitrogen (BUN >28mg/dL) and creatinine (Cr>1.5mg/dL) Uremia - azotemia with symptoms or signs of renal failure End Stage Renal Disease (ESRD) - uremia requiring RRT : transplantation or dialysis Chronic Renal Failure (CRF) - irreversible kidney dysfunction with azotemia >3 months Creatinine Clearance (CCr) - the rate of filtration of creatinine by the kidney (GFR marker) Glomerular Filtration Rate (GFR) - the total rate of filtration of blood by the kidney
Slide25Interstitial nephritis
Refers to group of diseases(acute & chronic)
characterised by presence of an inflammatory cell infiltrate in the renal interstitium and tubules & fibrosis in chromic condition.Sparing of vasculatures & glomeruli. Immune-mediated cause of acute renal failure
Slide26Pyelonephritis
Invasive kidney infection
Usually ascends from UTIFever, flank painOrganisms: E. coli, Proteus
Slide27Thank you