Glomerular diseases Year 4 Paediatrics Notes OmpathStudy

Glomerular diseases Year 4 · Paediatrics Collection: 4TH YEAR ALL NOTES / PAEDS / OTHER NOTES -- ● Objectives: ● Classify​ ​Glomerular​ ​diseases ● Understand​ ​the​ ​pathophysiology​ ​is​ ​correlated​ ​with​ ​the​ ​clinical​ ​manifestation​ ​in​ ​Glomerular\ndiseases. ● Recognize​ ​the​ ​clinical​ ​manifestations​ ​in​ ​Glomerular​ ​diseases ● Recognize​ ​the​ ​most​ ​common​ ​causes​ ​of​ ​Nephritic​ ​glomerular​ ​disease.\n[​ ​Color​ ​index​ ​:​ ​ ​Important​ ​ ​ ​ ​Notes​ ​ ​ ​Extra​ ​] ● Resources: ● 435​ ​slides,​ ​435​ ​renal​ ​pathology​ ​team,​ ​Step-Up​ ​to​ ​medicine,​ ​Master​ ​the​ ​boards​ ​and​ ​davidson.\n\n [​ ​ ​ ​ ​Editing​ ​file​ ​ ​ ​ ​ ​ ​ ​ ​ ​Feedback​ ​ ​ ​ ​ ​ ​ ​ ​ ​Share​ ​your​ ​notes​ ​ ​ ​ ​ ​ ​ ​ ​ ​Shared​ ​notes​ ​ ​ ​ ​ ​ ​ ​Twitter​ ​ ​ ​ ​]\n\n ★ Note​ ​:​ ​click​ ​here​ ​if​ ​you​ ​want​ ​ ​a​ ​quick​ ​review​ ​from​ ​basic​ ​sciences\n\n● Done​ ​by:​ ​Deema​ ​AlFaris​ ​&​ ​Khawla​ ​AlAmmari ● Team​ ​sub-leader:​ ​Shamma​ ​Alsaad ● Team​ ​leaders:​ ​Khawla​ ​AlAmmari​ ​&​ ​Fahad​ ​AlAbdullatif ● Revised​ ​by:​ ​Ahmad​ ​Alyahya \n\n Glomerular​ ​diseases\n\nGlomerular​ ​diseases​ ​:\n❖ Glomerular​ ​diseases​ ​account​ ​for​ ​a​ ​significant​ ​proportion​ ​of​ ​acute​ ​and​ ​chronic​ ​kidney\ndisease.​ ​There​ ​are​ ​many​ ​causes​ ​of​ ​glomerular​ ​damage,​ ​including​ ​immunological​ ​injury,\ninherited​ ​diseases​ ​such​ ​as​ ​Alport’s​ ​syndrome​,​ ​metabolic​ ​diseases​ ​such​ ​as​ ​diabetes​ ​mellitus​,\nand​ ​deposition​ ​of​ ​abnormal​ ​proteins​ ​such​ ​as​ ​amyloid​ ​in​ ​the​ ​glomeruli. How​ ​do​ ​glomerular​ ​diseases​ ​start​ ​?\n❖ We​ ​will​ ​be​ ​talking​ ​about​ ​primary​ ​glomerular​ ​diseases​ ​that​ ​are​ ​mostly​ ​caused​ ​by\nimmune​ ​system​ ​dysfunction​ ​How?​ ​Autoantibodies​ ​targeting​ ​glomerular​ ​structure​ ​or​ ​immune-complexes\n(antigen-antibody)​ ​depositing​ ​and​ ​traumatizing​ ​the​ ​glomerular​ ​components.\n➔ A​ ​lot​ ​of​ ​times​ ​the​ ​exact​ ​cause​ ​is​ ​not​ ​really​ ​clear,​ ​but​ ​the​ ​result​ ​of​ ​the​ ​damage​ ​in​ ​the​ ​glomerulus​ ​is​ ​telling​ ​how\nimmune​ ​system​ ​is​ ​playing​ ​an​ ​important​ ​rule.\n❖ The​ ​manifestations​ ​of​ ​a​ ​glomerular​ ​disease​ ​are​ ​usually​ ​indicative​ ​of​ ​which​ ​components​ ​of​ ​glomerular​ ​capillary\nwall​ ​was​ ​affected​ ​at​ ​the​ ​most,​ ​examples​ ​include:\n➔ if​ ​Podocytes​ ​are​ ​the​ ​main​ ​target​ ​of​ ​the​ ​disease​ ​process​ ​￫​ ​mainly​ ​proteinuria​ ​(at​ ​large​ ​amount)​ ​will\nmanifest​;​ ​thus​ ​Nephrotic​ ​Syndrome​ w ​ ill​ ​be​ ​the​ ​main​ ​finding.\n➔ If​ ​Endothelial​ ​cells​,​ ​Mesangial​ ​cells​ ​or​ ​GBM​ ​are​ ​affected​ ​￫​ ​mainly​ ​hematuria​ ​and​ ​abnormal​ ​renal\nfunction​ ​will​ ​manifest​ ​because​ ​of​ ​disruption​ ​in​ ​glomerular​ ​filtration​ ​wall;​ ​thus​ ​Nephritic​ ​pattern​ ​of\nrenal​ ​disease​ ​will​ ​manifest.​ ​(Note​ ​that​ P ​ roteinuria​ ​is​ ​always​ ​present​ ​in​ ​this​ ​kind​ ​of​ ​glomerular​ ​injury​ ​as\nwell).\n❖ Glomerular​ ​diseases​ ​are​ ​named​ ​based​ ​on​ ​their​​ ​histopathological​ ​characteristics​ ​seen​ ​under​ ​the​ ​microscope.​ ​So,\nalmost​ ​always​ ​a​ ​kidney​ ​biopsy​ ​is​ ​needed​ ​to​ ​diagnose​ ​any​ ​suspected​ ​primary​ ​glomerular​ ​disease. General​ ​points​ ​about​ ​Glomerular​ ​diseases​ ​:\n➔ Biopsy​ ​is​ ​the​ ​most​ ​accurate​ ​test​ ​to​ ​establish​ ​a​ ​diagnosis​ ​(though​ ​not​ ​always​ ​needed)\n➔ Glomerular​ ​diseases​ ​are​ ​usually​ ​chronic,​ ​they​ ​are​ ​often​ ​treated​ ​with​ ​corticosteroids.​ ​Additional\nimmunosuppressive​ ​medications​ ​(Cyclophosphamide,​ ​Mycophenolate)​ ​are​ ​frequently​ ​used.\n➔ To​ ​make​ ​things​ ​easier,​ ​we​ ​can​ ​put​ ​glomerular​ ​diseases​ ​in​ ​two​ ​main​ ​categories​ ​:​ ​Nephr​O​tic​ ​and​ ​Nephr​i​tic.\n➔ The​ ​major​ ​difference​ ​between​ ​“nephritic”​ ​and​ ​“nephrotic”​ ​is​ ​the​ ​amount​ ​of​ ​proteinuria.\n➔ Proteinuria​ ​levels​ ​correspond​ ​to​ ​severity​ ​of​ ​disease​ ​and​ ​likelihood​ ​of​ ​progression.\nGlomerular​ ​=​ ​S​low​ ​=​ ​S​ample​ ​=​ ​St​ eroids​ ​=​ ​Immuno​S​uppressive. \n\n How​ ​many​ ​milligrams​ ​of​ ​proteins​ ​are​ ​normally​ ​secreted​ ​in​ ​the​ ​urine​ ​per-day?\n❖ Normally​ ​ ​<​ ​150​ ​mg/day​ ​of​ ​all​ ​kinds​ ​of​ ​proteins.​ ​Including​ ​on​ ​average​ ​4-7​ ​mg/day​ ​of​ ​Albumin​ ​that​ ​are\nsecreted​ ​in​ ​the​ ​urine​ ​normally.​ ​In​ ​heavy​ ​proteinuria​,​ ​more​ ​than​ ​3.5​ ​g​ ​/24​ ​hrs​ ​(gram​ ​not​ ​milligram)​ ​of​ ​proteins\nwill​ ​be​ ​secreted​ ​into​ ​urine​ ​(more​ ​than​ ​3.5​ ​g​ ​/24​ ​hrs​ ​=​ ​nephrOtic​ ​range​ ​). \nClinical​ ​categories​ ​of​ ​glomerular​ ​diseases: \nNephrotic​ ​Syndrome1 Nephritic​ ​Glomerular​ ​Disease Clinical ◬ Urine​ ​analysis​ ​shows​ ​:2 ◬ Urine​ ​analysis​ ​shows​ ​: presentation ➔ Heavy​ ​protein​uria​ ​( 3.5g​ ​per​ ​24​ ​hrs​ ​of ➔ Hematuria\nurine​ ​collection)3 ➔ RBC​ ​casts​ ​:​ ​Formed​ ​by​ ​naturally​ ​occurring\n➔ Hypoalbumin​emia​ ​(<30​ ​g/L)​ ​“Normal​ ​serum Tamm-Horsfall​ ​mucoprotein​ ​in​ ​the​ ​distal​ ​tubules\nAlb