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so let's focus on what's happening when
we have an abnormal glomerulus and in
particular inflammation of that
glomerulus which is glomerulonephritis
as you recall from your histopathology
here's a normal glomerulus and here's an
abnormal glomerulus and you can see it
as heavily infiltrated with white blood
cells and inflammatory cells so the
inflammation of the glomerulus has many
potential causes and it can in turn
result in hematuria and proteinuria red
blood cell casts and that's a great way
to distinguish between
glomerulonephritis and cystitis and
sometimes can result in hypertension
through abnormal renin secretion or even
frank renal failure
so glomerulonephritis which is blood and
protein coming out spilling out of the
urine through that abnormal glomerulus
can be broken down into a few categories
it can be acute that usually has red
blood cell casts and that acute
glomerulonephritis may be either primary
something wrong with the kidney or
secondary something wrong systemically
alternatively glomerulonephritis may be
chronic and in this case often there are
not red blood cell casts and with
chronic disease again this can be either
primary or secondary so I want to go
through examples of diseases that are
either acute primary and secondary or
chronic primary and secondary so let's
start with acute glomerulonephritis this
is the one which often presents with red
blood cell casts we have primary and
secondary causes the primary causes
include commonly post drop glomerular
nephritis remember that treatment of
strep throat does not prevent
post-tropical Marylyn arthritis like it
does rheumatic fever it could be an
infectious glomerular nephritis
basically a pyelonephritis or it could
be a IgA nephropathy which is also
called burger
disease or it could be member nepali
furtive glimmering arthritis or MP GN
secondary causes of acute
glomerulonephritis are systemic problems
that will acutely cause the kidneys to
bleed the most common is
henoch-schonlein purpura also lupus can
do it or patients may have polyarteritis
nodosa which is is a systemic disease
that can involve the kidneys patients
may have hemolytic uremic syndrome which
absolutely causes renal damage this is
what you got after getting bad strains
of E coli patients may have subacute and
are carditis
which is flicking little clots which is
damaging the kidney and causing acute
bleeding or patients may have something
like Goodpasture syndrome which is an
inflammation of the basement membrane in
the kidney chronic glomerular nephritis
may result in significant bleeding this
is an ongoing issue these patients
typically don't have casts and the
primary causes include again member no
perda flyff proliferative
glomerulonephritis patients may have
membranous nephropathy
they could have focal glomerulus
chlorosis or they may have mesangial
proliferative nephritis those are all
chronic conditions that can cause a
primary glomerular nephritis and a
primary bleeding in the urine the
secondary causes of chronic are the same
as the first
HSP may become chronic in those
unfortunate patients who end up with
long-standing renal disease obviously
lupus polyarteritis nodosa hu s sub
acute endocarditis and Goodpaster
syndrome these can all be chronic
conditions so the diagnosis of
glomerular nephritis if you suspected is
not always made by a biopsy we do not
require biopsy in patients where there's
a clear explanation for the disease
examples would be post repla Marylyn
arthritis where we knew the child had
strep throat two weeks ago or the very
obvious situational conditions of
hemolytic uremic syndrome and
henoch-schonlein purpura if you want to
know more about these
there are separate lectures on those we
generally for those diseases target
therapy towards the underlying problem
as opposed to the kidneys
we can check c3 and c4 levels and that
can help us distinguish between some
causes of glomerulonephritis this is
important we typically see low c3 and
normalcy for in post strep
glomerulonephritis however we see low c3
and low c4 in lupus shunt nephritis and
bacterial endocarditis
so lupus has a low c3 and low c4 and
post strepek lamellar nephritis just
below c3 so for those patients where you
think it's post up lamenting the fright
Asst you get a low c3 and in a normalcy
for that child probably does not require
a biopsy the prognosis for
glomerulonephritis in general is
excellent
some of the diseases end up chronic but
that's the vast minority so 98% of
children will make a full recovery
whereas 2% will go on to have chronic
renal failure or some form of chronic
kidney disease that's a summary of
hematuria and glomerulonephritis thanks
for your attention
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you