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medicine.glumerulur dz.(dr.kawa)
Glomerular diseases affect the glomerulus and can cause proteinuria, hematuria, and acute or chronic kidney damage. The glomerulus contains podocytes, endothelial cells, mesangial cells, and parietal epithelial cells surrounded by the glomerular basement membrane. Glomerular diseases present as nephrotic syndrome, acute or rapidly progressive nephritic syndrome, chronic glomerulonephritis, or asymptomatic urinary abnormalities. Pathologies include focal, diffuse, segmental, or proliferative lesions affecting the mesangium, basement membrane, or causing crescent formation.
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medicine.glumerulur dz.(dr.kawa)
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- 2. Glomerular Diseases Microanatomy Thenephron is the basic unit of the kidney, each kidney contain about one million nephron. The nephron consist of the glomerulus &the associated tubules that lead to the collecting duct . The Glomerulus : is a ball of capillaries surrounded by Bowman’s capsule. The glomerulus receive blood from afferent arteriole & is drained by the efferent arteriole.
- 3. nephron the functional unitof the kidney •capable of forming urine •has two major components: glomerulus tubule: proximal loop of Henle distal collecting
- 4. The glomerulus contain4 different types of cells: 1- Visceral epithelial cell( podocytes ). these cells have long projections from which foot processes arise & attach to the glomerular basement membrane ( make support to the GBM ) . 2- Endothelial cells. these cells line the capillary lumen.
- 5. 3- Mesangial cells: the mesangium provide a skeletal framwork to support the capillary loops & have contractile & phagocytic properties. due to it’s contractile capability, can control blood flow along the glomerular capillaries . 4-Parietal epithelial cells: cover Bowman’s capsule . Glomerular Basement Membrane: prodused by fusion of the basement membrane of epithelial & endothelial cells .
- 6. Glomerular syndromes 1- Nephroticsyndrome : Massive proteinuria ( > 3.5 gm/24hr. ) , with variable edema, hypoalbuminemia, hyperlipidemia & hyperlipiduria . A- NS with “bland” sediment : mean pure NS. B-NS with “active” sediment : mean “mixed” Nephrotic/nephritic syndrome . Normal proteinuria <150 mg /24 hr(<0.15gm/24 hr) .
- 7. 2- Acute nephriticsyndrom : Nephronal hematuria (RBC cast &/or dysmorphic RBCs) temporally associated with acute renal failure . 3- Rapidly progressive glomerulonephritis : Nephronal hematuria (RBC cast &/or dysmorphic RBCs) with renal failure developing over weeks to months &diffuse glomerular crescent formation . 4-Chronic glomerulonephritis : slowly progressive glomerular damage with proteinuria, hematuria & hypertension .
- 8. 5-Asymptomatic urinary abnormalities: - Isolated proteinuria (usually <2 gm/day ) - hematuria (with or without proteinuria ) .
- 9. Pathologic features ofglomerular disease Focal :mean affect some of glomeruli (but not all ). Diffuse : mean the lesion affect all glomeruli or >75% . Segmental : mean only a part of the glomerulus is affected by the lesion . Proliferative : abnormal proliferation of
- 10. Misangial :excessive productionof misangial materials. Membranous :glomeruler basement is damaged &thickened . Membranoproliferative :causing both thickening of glomerular basement membran &proliferation of mesangial cells . Crescent formation: epithelial cell proliferation & mononuclear cell infiltration in Bowman’s space.