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    Glomerular Disease: Nephrotic vs. Nephritic

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    Marcel Doc
    The document discusses glomerular disease and compares nephrotic and nephritic syndromes. It describes the glomerular filtration barrier and how its charge and size properties allow selective filtering of molecules. It defines proteinuria and its types, and explains the clinical presentations and complications of nephrotic syndrome including edema, hyperlipidemia, and hypoalbuminemia. Nephritic syndrome is characterized by hematuria, reduced GFR, and hypertension rather than the edema seen in nephrotic syndrome.

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    Glomerular Disease: Nephrotic vs. Nephritic

    Uploaded by

    Marcel Doc
    89 views26 pages
    The document discusses glomerular disease and compares nephrotic and nephritic syndromes. It describes the glomerular filtration barrier and how its charge and size properties allow selective filtering of molecules. It defines proteinuria and its types, and explains the clinical presentations and complications of nephrotic syndrome including edema, hyperlipidemia, and hypoalbuminemia. Nephritic syndrome is characterized by hematuria, reduced GFR, and hypertension rather than the edema seen in nephrotic syndrome.

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    The document discusses glomerular disease and compares nephrotic and nephritic syndromes. It describes the glomerular filtration barrier and how its charge and size properties allow selective filtering of molecules. It defines proteinuria and its types, and explains the clinical presentations and complications of nephrotic syndrome including edema, hyperlipidemia, and hypoalbuminemia. Nephritic syndrome is characterized by hematuria, reduced GFR, and hypertension rather than the edema seen in nephrotic syndrome.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    89 views26 pages

    Glomerular Disease: Nephrotic vs. Nephritic

    Uploaded by

    Marcel Doc
    The document discusses glomerular disease and compares nephrotic and nephritic syndromes. It describes the glomerular filtration barrier and how its charge and size properties allow selective filtering of molecules. It defines proteinuria and its types, and explains the clinical presentations and complications of nephrotic syndrome including edema, hyperlipidemia, and hypoalbuminemia. Nephritic syndrome is characterized by hematuria, reduced GFR, and hypertension rather than the edema seen in nephrotic syndrome.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    of 26

    Glomerular

     disease
    Nephrotic  Vs.  Nephritic  
    Presented  by:  Sarah  Al  Qubaiban
    Objectives  
    • Anatomy  of  glomerulus.  
    • Proteinuria  and  its  types.
    • Glomerulonephritis.
    • Nephrotic  syndrome  (briefly).  
    • Nephritic  syndrome  (briefly).  
    Glomerular  Filtration  Barrier  
    (GFB)  
    • GFB  is  composed  of  three  
    layers:
    • The  endothelial  layer  of  the  
    glomerulus  capillaries  
    • The  basement  membrane
    • The  epithelial  layer  of  
    bowman  capsule  
    • The  visceral  part  which  contains  
    podocytes  
    Properties  of  these  layers  
    • Endothelial   layer
    • Fenestrated  cells
    • Contain  pores  60  – 100  nm  
    • Glomerular  basement  membrane
    • Nega7vely  charged  because  of  Heparan-­‐sulfate  proteoglycans
    • Thickness  321  nm*  
    • Epithelial   layer
    • Contains  slits  which  are  the  gaps  between  the  inter-­‐digita7on  
    of  the  podocytes,  size  20-­‐30  nm
    • Niphrin and  podocin are  major  component  of  the  slits  

    – *hRp://www.ncbi.nlm.nih.gov/pubmed/16366093  
    • Any  molecule  that  has  to  inter  the  tubules,  it  needs  
    to  pass  through  the  
    • Charge  barrier  
    • Physical  (size)  barrier  
    • o  <4nm:  all  charged  molecules  pass.  
    • 4-­‐8:  only  +  charge  pass.
    • >8  :  no  filtration.  
    Glomerulonephritis  
    • Classified  as  
    • Hereditary  (e.g.  Alport’s and  Fabry’s syndromes)  
    • Primary  (most  common):  disease  process  originates  
    from  the  glomerulus  
    • Secondary  to  systemic  diseases:  e.g.  systemic  lupus  
    erythematosus  (SLE),  diabetes  mellitus,  bacterial  
    endocarditis.  
    Primary  GN  
    Presentation  of  GN  
    • Asymptomatic  proteinuria  
    • Asymptomatic  
    heamatoureia
    • Nephrotic  syndrome  
    • Nephritic  syndrome  
    • Rapidly  progressive  GN  
    • Chronic  kidney  disease  
    Proteinuria

    Selective  proteinuria   Non-­‐selective  proteinuria   Non-­‐selective  proteinuria  


    albumen   urea  Less  than   more  than  3.5  
    3.5 Nephrotic  range  
    Sub-­‐nephrotic   range  
    Proteinuria  cnt.  
    • Types  
    • Selective:  only  albumin  
    • Non-­‐selective:  albumin  +  globulin  
    • Sub-­‐nephrotic  range:  ↓3.5\day
    • Nephrotic  range:  ↑3.5\day  
    • pt.  complains  of  frothy  urine  because  of  high  
    protein  level.  
    • Other  symptoms  appear.  
    Proteinuria

    • Liver   compensates   hypoprotenuria by  synthesizing  new  


    Hypoproteinemia   proteins   including   :   LDL,   IDL,  V LDL,   Triglycerides  

    • Other   causes   of  HL:


    •   ↓  level   of  lipoprotein   lipase  
    Dyslipidemia which   aids  the   breakdown  of  
    lipids.  

    •If  HL  is  chronic.


    •PCT  cell  will  uptake  the  
    fat  and  form  lipoid  
    Lipiduria nephrosis   ,  later  these  
    cells  become  
    dysfunc7onal  and  shed  
    with  urine.  
    • Despite  the  production  of  protein,  it  is  still  leaking  into  
    the  urine.  
    • Hydrostatic  &  oncotic  pressure  disturbed  
    • Fluid  leaks  out  to  the  interstitiam
    • Hypovolemia  develops  
    • Renin-­‐Angiotensin-­‐System  will  be  activated  &  ADH   will  
    be  produced  in  large  amount  because  of  ↑  in  the  
    osmolality  which  will  be  sensed  by  the  hypothalamus  
    as  will  as   aldosterone  
    • Protein  concentration  is  still  low  so  more  edema  will  
    develop.  
    Extracellular  fluid  volume Low-­‐output   cardiac  failure,   Intravascular  volume  
    pericardial  tamponade,   secondary  to  
    constrictive  pericarditis   diminished  oncotic  
    pressure  or  
    increased  capillary  
    Cardiac  output
    permeability

    Activation  of  ventricular  


    and  
    arterial  receptors

    Nonsmotic Stimulation  of   Activation  of  the  


    vasopressin   sympathetic  nervous   renin-­‐angiotensin-­‐
    stimulation system aldosterone  system

    Renal  water   Peripheral  and  renal   Renal  sodium  


    retention arterial  vascular  resistance   retention
    • NEPHROTIC  SYNDROME  triad:
    • Proteinuria  
    • Edema
    • Hyperlipidemia  

    NEPHROTIC  SYNDROME:  is  clinico-­‐pathological  


    condition  which  develops  when  there  is  significant  
    damage  to  the  glomeruli  leading  to  proteinuria  
    >3.5g\day.  
    Causes  of  Nephrotic  syndrome
    • Complications  
    • Hypercoagulable  state
    – Loss  of  an7-­‐thrombin  3
    – Increase  in  blood  concentra7on  and  thus  decrease  the  flow
    – Increase  in  plasma  lipid  will  irritate  platelets  and  the  vessels  
    walls  
    • Immunosuppression  •  Hyperlipidemia
    • Hypertension
    • Edema  
    – Generalized  edema(  anasarca)   which  start  peri-­‐orbital  
    then  in  the  dependent  areas  then  allover  the  body.  
    • Iron  deficiency  Anemia
    – Leak  down  of  transferrin  into  urine  
    Investigation  
    • Urinalysis
    • Urine  sediment  examination  
    • Urinary  protein  measurement  
    • Serum  albumin  
    • Serologic  studies  for  infection  and  immune  
    abnormalities  
    • Renal  ultrasonography  
    • Renal  biopsy  
    How  to  manage  NS  
    • Usually  management  is  symptomatic  +  treating  the  
    underlying  cause  if  possible.  
    • Symptomatic  management  will  include:
    • Blood  pressure  control
    • Reduction  of  proteinuria,  (ACE)  inhibitors
    • Control  of  hyperlipidemia
    • Anticoagulation  if  hypercoagulable
    • Diuretics  if  the  ptx complaining  of  edema  
    Nephritic  syndrome  
    • Due  to  severe  glomerular  injury;  
    • Hematuria
    • RBC   cast  
    • Dysmorphic  RBS  
    • Oliguria   ↓400ml  due  to  decrease  in  the  GFR  
    • Increase  in  blood  pressure  →  RAS  because  decrease  in  
    kidney  perfusion  
    • azotemia  
    • Kidney  enlargement  
    • Proteinuria  but  less  than  nephro7c  syndrome  because  
    the  total  filtra7on  is  reduced.  
    Causes  of  nephritic  syndrome  
    Nephrotic  vs  Nephritic  
    Summary  
    • The  filtration  barrier,  its  components  and  properties.  
    ü Charge  barrier  
    ü Size  barrier  

    • Proteinuria  and  its  types  


    ü Selective  
    ü Non-­‐ selective  
    • Glomerular  diseases  
    ü Primary  
    ü Secondary  
    ü Hereditary  

    • Nephrotic  and  nephritic  syndromes  


    ü Clinical  presentation  
    ü Pathogenesis
    ü Common  causes
    ü Investigations  and  management  
    References

    – Dr.  Najeeb lectures  


    • Nephtotirc vs.  nephritic
    – Crash  course  renal  and  urinary  system  
    For  any  questions  or  comments  
    please  contact  us  at:
    [email protected]

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