Pediatric Glomerulonephritis - Pediatrics | Lecturio
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This video “Pediatric Glomerulonephritis” is part of the Lecturio course “Pediatrics” ► WATCH the complete course on lectur.io/pediatricglomerulone...
► LEARN ABOUT:
- Pathology of Glomerulonephritis
- Acute Glomerulonephritis
- Chronic Glomerulonephritis
- Diagnosis of Glomerulonephritis
► THE PROF:
Your tutor is Brian Alverson, MD. He is the Director for the Division of Pediatric Hospital Medicine at Hasbro Children's Hospital and Associate Professor of Pediatrics at Brown University in Providence, RI. He has been active in pediatric education and research for 15 years and has won over 25 teaching awards at two Ivy League Medical Schools. Dr. Alverson has extensive experience in preparing students for the USMLE exams and has test writing experience as well.
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Pediatric Granulomatosis with Polyangiitis (Wegener’s Granulomatosis) and Goodpasture Syndrome (GPS)
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It was a joy to watch this brief, interesting and informative lecture.
This guy is just AWESOME.
Awesomely informative and perfectly explained! Thank you so much! 😊😊 11/6/2019
❤
Rewatched again! Thank you so much! 30/11/2020
Nice to see someone studying as me
Good presentation I appreciate it
Amazing
thank you sir
Thanks 😊, it's more helpful in my study
Nice one
Sir my daughter suffered with e-coli infection frequently for every 3months then I continue the treatment with anti biotic,but now urine often coming with RBC and puscells especially at evening time,but no infection found in routine and culture urine test,and also she can't take fatty food
Ippudu tagginda sir
So let's focus on what's happening when we have an abnormal glomerulus and in particular inflammation of that glomerulus which is glomerulonephritis. As you recall from your histopathology here's a normal glomerulus and here's an abnormal glomerulus. And you can see it as heavily infiltrated with white blood cells and inflammatory cells. 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 and sometimes can result in hypertension through abnormal renin secretion or even frank renal failure.
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. It can be acute that usually has red blood cell casts. And that acute glomerulonephritis may be either primary something wrong with the kidney or secondary something wrong systemically. Alternatively glomerulonephritis may be chronic and in this case often there are not red blood cell casts. And with chronic disease again this can be either primary or secondary.
So I want to go through examples of diseases that are either acute primary and secondary or chronic primary and secondary. So let's start with acute glomerulonephritis. This is the one which often presents with red blood cell casts. We have primary and secondary causes. The primary causes include commonly post drop glomerular nephritis. Remember that treatment of strep throat does not prevent post-tropical glomerulonephritis like it does rheumatic fever. It could be an infectious glomerulonephritis. Basically a pyelonephritis. Or it could be a IgA nephropathy which is also called Berger’s disease. Or it could be member nepali furtive glomerulonephritis or MPGN.
Secondary causes of acute glomerulonephritis are systemic problems that will acutely cause the kidneys to bleed. The most common is henoch-schonlein purpura. Also lupus can do it or patients may have Polyarteritis Nodosa which’s is a systemic disease that can involve the kidneys. Patients may have hemolytic uremic syndrome which absolutely causes renal damage this is what you got after getting bad strain of E.coli.
Patients may have Subacute endocarditis which is flicking little clots which is damaging the kidney and causing acute bleeding. Or patients may have something like Goodpasture syndrome which is an inflammation of the basement membrane in the kidney. Chronic glomerulonephritis may result in significant bleeding this is an ongoing issue. These patients typically don't have casts and the primary causes include again member no perda flyff proliferative glomerulonephritis patients may have Membranous nephropathy. They could have Focal glomerulosclerosis or they may have Mesangial proliferative nephritis. Those are all chronic conditions that can cause a primary glomerulonephritis and a primary bleeding in the urine. The secondary causes of chronic are the same as the first.
HSP may become chronic in those unfortunate patients who end up with long-standing renal disease obviously lupus, Polyarteritis nodosa , HUS, Subacute endocarditis and Goodpaster syndrome. These can all be chronic conditions. So the diagnosis of glomerulonephritis if you suspected is not always made by a biopsy. We do not require biopsy in patients where there's a clear explanation for the disease. Examples would be Post-Streptococcal 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.
If you want to know more about these there are separate lectures on those. We generally for those diseases target therapy towards the underlying problem as opposed to the kidneys. We can check C3 and C4 levels and that can help us distinguish between some causes of glomerulonephritis. This is important. We typically see low C3 and normalcy for in post strep glomerulonephritis. However we see low C3 and low C4 in lupus shunt nephritis and bacterial endocarditis. So lupus has a low C3 and low C4 and Post-Streptococcal Glomerulonephritis just below C3. So for those patients where you think it's post up glomerulonephritis you get a low C3 and in a normal C4 that child probably does not require a biopsy.
The prognosis for glomerulonephritis in general is excellent. Some of the diseases end up chronic but that's the vast minority. 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. That's a summary of hematuria and glomerulonephritis.
Excellent presentation ❤
Thanks a lot 😊
Recovery untada sir
Sir my son is having microscopic hematuria since four months .... his c3 and c4 level is normal.
He had two instances of proteinaria 1+ for 24hr to 48hr when he was having fever and uper respiratory tract infection 3 months before and fever and intestinal infection two months before during which it turned into gross hematuria for one to two days. We did all tests except kidney biopsy ... and all test are normal. Morphology of RBC is normal. This microscopic hematuria is persistent with 40 -60 RBC in morning urine and 20 to 30 RBC during day time. He does not have any other symptoms of glomerulonephritis What should we do?
Hi, Are you still having this? as my daughter have microscopic hematuria as well as proteinaria 1+
So the diagnosis of glomerulonephritis if you suspected is not always made by a biopsy. We do not require biopsy in patients where there's a clear explanation for the disease. Examples would be Post-Streptococcal 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.
If you want to know more about these there are separate lectures on those. We generally for those diseases target therapy towards the underlying problem as opposed to the kidneys. We can check C3 and C4 levels and that can help us distinguish between some causes of glomerulonephritis. This is important. We typically see low C3 and normalcy for in post strep glomerulonephritis. However we see low C3 and low C4 in lupus shunt nephritis and bacterial endocarditis. So lupus has a low C3 and low C4 and Post-Streptococcal Glomerulonephritis just below C3. So for those patients where you think it's post up glomerulonephritis you get a low C3 and in a normal C4 that child probably does not require a biopsy.
The prognosis for glomerulonephritis in general is excellent. Some of the diseases end up chronic but that's the vast minority. 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. That's a summary of hematuria and glomerulonephritis.
So lets focus on whats happening when we have an abnormal glomerulus and in particular inflammation of that glomerulus which is glomerulonephritis as you recall from your histopathology heres a normal glomerulus and heres an abnormal glomerulus and you can see it
as heavily infiltrated with white blood cells and inflammatory cells 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 thats a great way to distinguish between glomerulonephritis and cystitis and
sometimes can result in hypertension through abnormal renin secretion or even frank renal failure 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 it can be acute that usually has red blood cell casts and that acute glomerulonephritis may be either primary something wrong with the kidney or secondary something wrong systemically alternatively glomerulonephritis may be chronic and in this case often there are not red blood cell casts and with chronic disease again this can be either primary or secondary so i want to go through examples of diseases that are either acute primary and secondary or chronic primary and secondary so lets start with acute glomerulonephritis this is the one which often presents with red blood cell casts we have primary and secondary causes the primary causes include commonly post strep glomerular nephritis remember that treatment of strep throat does not prevent post strep glomerulonephritis like it does rheumatic fever it could be an infectious glomerular nephritis basically a pyelonephritis or it could be a iga nephropathy which is also called burger disease or it could be member nepali furtive glimmering arthritis or mp gn secondary causes of acute glomerulonephritis are systemic problems that will acutely cause the kidneys to bleed the most common is so let's focus on what's happening when proliferative nephritis thos purpura also lupus can do it or patients may have polyarteritis nodosa which is is a systemic disease that can involve the kidneys patients may have hemolytic uremic syndrome which absolutely causes renal damage this is what you got after getting bad strains of e coli patients may have subacute and are carditis which is flicking little clots which is damaging the kidney and causing acute bleeding or patients may have something like goodpasture syndrome which is an inflammation of the basement membrane in the kidney chronic glomerular nephritis may result in significant bleeding this is an ongoing issue these patients typically dont have casts and the primary causes include again member no perda flyff proliferative glomerulonephritis patients may have membranous nephropathy they could have focal glomerulus chlorosis or they may have mesangial proliferative nephritis those are all.
chronic glomerular nephritis
may result in significant bleeding this
is an ongoing issue these patients
typically don't have casts and the
primary causes include again member no
perda flyff proliferative
glomerulonephritis patients may have
membranous nephropathy
they could have focal glomerulus
chlorosis or they may have mesangial
proliferative nephritis those are all
chronic conditions that can cause a
primary glomerular nephritis and a
primary bleeding in the urine the
secondary causes of chronic are the same
as the first
HSP may become chronic in those
unfortunate patients who end up with
long-standing renal disease obviously
lupus polyarteritis nodosa hu s sub
acute endocarditis and Goodpaster
syndrome these can all be chronic
conditions so the diagnosis of
glomerular nephritis if you suspected is
not always made by a biopsy we do not
require biopsy in patients where there's
a clear explanation for the disease
examples would be post repla Marylyn
arthritis 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 if you want to
know more about these
there are separate lectures on those we
generally for those diseases target
therapy towards the underlying problem
as opposed to the kidneys
we can check c3 and c4 levels and that
can help us distinguish between some
causes of glomerulonephritis this is
important we typically see low c3 and
normalcy for in post strep
glomerulonephritis however we see low c3
and low c4 in lupus shunt nephritis and
bacterial endocarditis
so lupus has a low c3 and low c4 and
post strepek lamellar nephritis just
below c3 so for those patients where you
think it's post up lamenting the fright
Asst you get a low c3 and in a normalcy
for that child probably does not require
a biopsy the prognosis for
glomerulonephritis in general is
excellent
some of the diseases end up chronic but
that's the vast minority 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 that's a summary of
hematuria and glomerulonephritis thanks
for your attention