00:01
So let’s focus on what’s happening when we have an abnormal glomerulus
and in particular, inflammation of the glomerulus which is glomerulonephritis.
00:11
As you recall from your histopathology,
here’s a normal glomerulus and here’s an abnormal glomerulus
and you can see it is heavily infiltrated
with white blood cells and inflammatory cells.
00:23
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.
00:41
And sometimes can result in hypertension
through abnormal renin secretion or even frank renal failure.
00:50
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.
01:03
It can be acute that usually has red blood cell casts
and that acute glomerulonephritis maybe either primary,
something wrong with the kidney,
or secondary, something wrong systemically.
01:16
Alternatively, glomerulonephritis maybe chronic.
01:19
And in this case often, they are not red blood cell casts
and with chronic disease, again this can be either primary or secondary.
01:29
So I want to go through examples of diseases that are either acute,
primary and secondary or chronic, primary and secondary.
01:37
So let’s start with acute glomerulonephritis.
01:41
This is the one which often presents with red blood casts.
01:45
We have primary and secondary causes.
01:48
The primary causes include commonly post-strep glomerulonephritis.
01:53
Remember, that treatment of strep throat does not prevent
post-strep glomerulonephritis like it does rheumatic fever.
02:01
It could be an infectious glomerulonephritis, basically a pyelonephritis,
or it could be IgA nephropathy which is also called Berger’s disease.
02:11
Or it could be membranoproliferative glomerulonephritis or MPGN.
02:16
Secondary causes of acute glomerulonephritis are systemic problems
that will acutely cause the kidneys to bleed.
02:26
The most common is Henoch-Schonlein purpura.
02:29
Also, lupus can do it
or patients may have polyarteritis nodosa
which is a systemic disease that can involve the kidneys.
02:38
Patients may have hemolytic uremic syndrome which absolutely causes renal damage.
02:43
This is what you got after getting bad strains of E. coli.
02:47
Patients may have subacute endocarditis which is flicking little clots
which is damaging the kidney and causing acute bleeding.
02:55
Or patients may have something like Goodpasture syndrome
which is an inflammation of the basement membrane in the kidney.
03:01
Chronic glomerulonephritis may result in significant bleeding.
03:08
This is an ongoing issue.
03:10
These patients typically don’t have casts
and the primary causes include again membranoproliferative glomerulonephritis.
03:19
Patients may have membranous nephropathy.
03:22
They could have focal glomerulosclerosis
or they may have mesangial proliferative nephritis.
03:28
Those are all chronic conditions that can cause a primary glomerulonephritis
and a primary bleeding in the urine.
03:36
The secondary causes of chronic are the same as the first.
03:40
HSP may become chronic in those unfortunate patients
who end up with longstanding renal disease, obviously lupus,
polyarteritis nodosa, HUS, subacute endocarditis and Goodpasture syndrome.
03:53
This can all be chronic conditions.
03:55
So the diagnosis of glomerulonephritis, if you suspect it,
is not always made by a biopsy.
04:03
We do not require biopsy in patients where there is clear explanation for the disease.
04:08
Examples would be post-strep glomerulonephritis
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.
04:22
If you want to know more about these diseases,
there are separate lectures on those.
04:26
We generally, for those diseases, target therapy towards the underlying problem
as opposed to the kidneys.
04:34
We can check C3 and C4 levels
and that can help us distinguish between some causes of glomerulonephritis.
04:43
This is important.
04:45
We typically see low C3 and normal C4 in post-strep glomerulonephritis.
04:53
However, we see low C3 and low C4 in lupus,
shunt nephritis and bacterial endocarditis.
05:03
So lupus has a low C3 and low C4
and post-strep glomerulonephritis just a low C3.
05:12
So for those patients where you think it’s post-strep glomerulonephritis,
you got a low C3 and a normal C4, that child probably does not require a biopsy.
05:22
The prognosis for glomerulonephritis in general is excellent.
05:28
Some of the diseases end up chronic but that’s the vast minority.
05:32
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.
05:42
That’s a summary of hematuria and glomerulonephritis.
05:46
Thanks for your attention.