II) Acute GN

1. II) Acute GN 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.

2. Acute 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

3. III) Nephrotic Syndrome Case • 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?

4. Proteinuria Mechanisms • 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

5. Nephrotic Syndrome

6. Nephrotic Syndrome

7. Nephrotic Syndrome Definition (Screiner, 1971) • “A clinical entity having multiple causes and characterized by increased glomerular permeability manifested by massive proteinuria and lipiduria. There is a variable tendency towards edema, hypoalbuminemia and hyperlipidemia. Protein excretion rates are usually in excess of 3.5 g/day/1.73m2 body surface in the absence of a depressed GFR.”

8. Nephrotic Syndrome Differential Diagnosis • Minimal change • FSGS • Membranous • MPGN • IgA • nodular – amyloidosis, DM, fibrillary

9. Nephrotic Syndrome

10. Minimal Change Disease

11. FSGS

12. Membranous Nephropathy