2. Definition
Structure of glomerulus
Causes
Minimal change
Membranous Glomerulonephritis
Focal segmental Glomerulosclerosis
Investigations
Prognosis and complications
Treatment
Random quiz
3. Manifestation of glomerular disease defined
by:
Proteinuria (>3.5g per day)
Hypoalbuminaemia (< 30 g/l)
Generalized oedema and hyperlipidaemia
4. Fenestrated
endothelial cells
GBM
Podocytes found
on Glomerular
epithelial cells
Zip like
structure
including
from proteins
e.g. nephrin
Linker
proteins
include
podocin
1. GBM – certain collagens and heparin
like molecules arranged. Size and
charge selection. Albumin not pass,
haemaglobin can (67,000) Myoglobin
(17,000) and monomeric light chains
(22,000) can pass through
2. Between podocytes a thin digapragms
consisting of proteins such as
nephrin(mutations of proteins such as
nephrin have been found to cause
some nephritic syndrome)
3. Normal urine contains small amount of
protein (150mg/day)
5. Primary glumerular disease
Minimal change
Membranous glomerulonephritis
Focal segmental glomerulosclerosis
Systemic Disease
Diabetes
SLE
Amyloid
Drugs
NSAIDS
Penicillamine
Gold
• Neoplasm
• Any sold organ tumour
• Leukaemia
• Lymphoma
• Infection
• Malaria
• Streptococcal
• Hep B and C
• HIV
• Vascular
• Malignant hypertension
9. Commonest cause in children
80 – 90% GN in children (20% in adults)
More common in boys
Only 1% lead to chronic renal failure
80% have recurrence
Responds well to treatment
Associations e.g. Hodgkins lymphoma
13. 20 – 30% of nephrotic syndrome in adults (2-
5%children)
Primary or idiopathic but can be secondary such as
Automimmune – SLE, thyroid disease
Drugs – gold, penicillamine, captopril
Infection – HBV, syphilis, leprosy, filiariasis
Risk of chronic renal failure
Treatment aimed at cause, can use
immunosupression
Untreated 40% remission
16. Can occur at any age
Primary or secondary
Reflux IgA nephropathy
Alport’s syndrome
Vasculitis
Sickle cell disease
Heroin use
HIV
50% have impaired renal function
Responds to corticosteroids in 30%
30 – 50% progress to ESRF
Risk of recurrence post transplant in 20 – 30%
17. (A) An early lesion with
segmental capillary collapse and
epithelial hyperplasia (arrows).
(B and C) Glomeruli show more
extensive abnormalities with on
top of collapsed capillaries with
epithelial hyperplasia more
advanced lesions (arrowheads)
with sclerosis, adhesions,
epithelial hyperplasia, and mild
endocapillary hypercellularity
with endocapillary foam cells.
(D) A hypocellular globally
sclerotic glomerulus covered
with a single layer of epithelial
cells, which do not appear,
activated.
19. Depends on underlying disease
Can be affected by degree of proteinuria, HLA type
and creatinine
Complications
Hypercholesterolaemia
Infection (receive oneumococcal vac)
Thrombosis
Renal Failure
Malnutrition
20. Treat underlying cause
Keep blood pressure down
Corticosteroids Cyclophosphamide or
ciclosporin
Minimal change Yes If frequent relapse
Membranous Based on poor
prognostic factors
If renal function
deteriorates
Focal segmental Yes –remission in 30% If steroid resistant
21.
22. Linus Pauling
Bright's disease
2 x Nobel prize
Demonstrated that the
hemoglobin molecule
changes structure when
it gains or loses an
oxygen
DNA triple helix?
23. Alonzo Harding Mourning
Played for Miami Heat
Had Focal segmental
Glomerulosclerosis
Had a kidney transplant
and later won his first NBA
Championship with the
Heat
25. OHCM
The renal system - Michael field, Carol Pollock, David Harris
Schieppati A, MosconiL, Perma A et al. Prognosis of
untreated patients with idiopathic membranous
nephropathy. New England Journal of Medicine 1993;329: 85
-89
Tune BM, Mendoza SA.Treatment of the idiopathic
nephrotic syndrome: regimens and outcomes in children and
adults, Journal of the American Society of Nephrology 1997;
8: 824 - 832
