- Nephrotic and nephritic syndrome.pptx

Nephritis syndrome

1. Nephrotic ,nephritic syndromes and renal failure -DR. DIKSHA KUMAR

2. Structure of kidney

3. GLOMERULAR DISEASES Involves the glomeruli of the kidney Presentation of these glomerular diseases can be- Nephritic and nephrotic syndrome Acute and chronic renal failure Asymptomatic haematuria or proteinuria

4. Glomerular diseases are of two types- Primary glomerular diseases- main site of involvement Secondary glomerular diseases- Systemic diseases with secondary affect on glomeruli

5. NEPHRITIC SYNDROME Acute onset of glomerular disease post infective illness for about 10-20 days, presents with- 1. Haematuria- smoky urine 2. Proteinuria- mild(<3 gm/ 24 hrs) 3. Hypertension- generally mild 4. Oedema- mild due to sodium water retention 5. Oliguria- variable

6. Causes of nephritic syndrome

7. NEPHROTIC SYNDROME Not a disease but a presentation of a disease Constellation of features as a result of kidney injury

8. Features of nephrotic syndrome 1. Massive proteinuria protein loss of more than 3gm/24 hrs. Normally protein reabsorbed 100% in tubules In this case mostly- albumin loss

9. 2. Hypoalbuminemia Urinary loss of albumin Causes decrease in plasma albumin levels Reverse A/G ratio

10. 3. Oedema Sequalae of hypoalbuminemia Decreased colloid pressure Sodium water retention

11. 4. Hyperlipidemia Increased blood levels of total lipids, cholesterol, triglycerides, VLDL and LDL but decrease in HDL 5. Lipiduria 6. Hypercoagulibility

12. Causes of nephrotic syndrome

13. Causes contd.

14. NEPHRITIC VS NEPHROTIC SYNDROME

15. ACUTE RENAL FAILURE Rapid onset of renal dysfunction- oliguria/anuria Sudden increase in metabolic waste products- urea, creatinine Subsequent uraemia Causes- Pre-renal Intra-renal Post-renal

16. Pre renal causes Sudden decrease in flow to the nephron Renal ischemia Decrease in GFR and functional disorders Due to- Decreased cardiac output -Hypovolemia -vascular diseases

17. Intra-renal causes Disease of renal tissue 1.Vascular diseases within kidney 2.Glomerular diseases 3.Acute tubular necrosis 4.Pyelonephritis 5.Acute tubulointerstitial nephritis

18. Post-renal causes Due to obstruction to the flow of urine along the tract Caused by- 1. Mass within the lumen 2. External compression

19. Clinical presentation Patterns of presentation 1. Syndrome of acute nephritis - Decrease GFR - Mild increase in epithelial permeability

20. 2. Syndrome accompanying tubular pathology Due to destruction of tubular cells 3 phases: Oliguric phase-decrease in urine output Diuretic phase-low specific gravity urine Phase of recovery-restoration of normal function 3. Pre-renal syndrome- secondary to systemic diseases

21. Chronic renal failure Syndrome- progressive and irreversible deterioration of renal function Destruction of renal parenchyma Results in death Can be due to- Glomerular pathology- glomerulonephritis, SLE, diabetic nephropathy

22. 2. Tubulointerstitial pathology Vascular causes- Hypertension causing nephrosclerosis Infectious causes-Chronic pyelonephritis Toxic causes-High dose of drugs and heavy metal exposure Obstructive causes-stones, clots, strictures, enlarged prostate

23. Stages of CRF 4 stages of Chronic renal failure- Decreased renal reserve GFR 50% normal,BUN and creatinine- normal Patient asymptomatic 2. Renal insufficiency -75% loss of renal function -polyuria and nocturia

24. 3. Renal failure 90% tissue destroyed Results in oedema, metabolic acidosis, hypocalcemia and uremia 4. End stage renal disease -<5% GFR Uremia Systemic and renal symptoms

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