Urinary syndrome
Clinical manifestation: latent course, no complaints.
Urine tests
•Hematuria (commonly microhematuria)
•Leucocyturia
•Proteinuria (< 3 g/24 h)
Nephritic syndrome
•Etiology :
InfectionVaccinationsSystemic diseases
•Clinical manifestations
edema (face, eye lids)oliguriaHypertension
Proteinuria, hematuria («meat slops»)
±lung edema, acute renal failure
Clinical case 1
Nephrotic syndrome
Diagnostic criteria
•Massive proteinuria (>3.5 g/24 h)
•Hypoalbuminuria (< 35 g/l)
•Disproteinemia (hyper-α2-globulinemia)
•Dislipidemia
•Edema (due to of serum oncotic pressure and retention of Na )
Edema (nephrotic syndrome)
COMMOM CAUSES OF NEPHROTIC SYNDROME
Non-inflammatory glomerulonephritis
Minimal change nephropathy
Focal and segmental glomerulosclerosis (FSGS)Membranous nephropathy
Proliferative/inflammatory glomerulonephritis
Mesangiocapillary glomerulonephritis (MCGN)Other “subacute” proliferative nephritis
Systemic lipus erythematosus (SLE) (with a variety of histopathological types)
Systemic diseases
Diabetic nephropathyAmyloidosis
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CONSEQUENCES AND COMPLICATIONS
OF NEPHROTIC SYNDROME
Oedema
Caused by avid sodium retention and hypoalbuminaemia
Hypercoagulability
Presumed relative loss of inhibitors of coagulationVenous thromboembolism is common and sometimes fatal
Hypercholesterolaemia
High rate of arterial occlusions and disease
Infection
Especially by pneumococci
Associated with hypogammaglobulinaemia
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Hypertensive syndrome
•Patogenesis : retention of Na and water due to activation of renin-angiotensin-aldosteron system (RAAS) and depression of prostaglandin-callecrein system function.
•Clinical manifestation: depends on degree of BP elevation and damage of cardiovascular system
Changes in urine appears before increase of BP and usually are moderate
Hypertensive syndrome
• May be detected in:
acute glomerulonephritis acutely progressive (crescent) GN hypertensive and mixed GN chronic pyelonephritis
chronic kidney failure renal artery stenosis
Uncommon in latent course of chronic GN and chronic interstitial nephritis