Nephritic Nephrotic
Etiologies Primary Primary
- IgA Nephropathy / Berger - Minimal Change Disease
- Postinfectious Glomerulonephritis - APSGN - Focal Segmental Glomeruloscleros
- Membranoproliferative Glomerulonephritis - Membranous Nephropathy
Secondary - Membranoproliferative Glomerulon
- Henoch-Schönlen Vasculitis Secondary
- Goodpasture Syndrome - Diabetic Nephropathy
- Wegner's Granulomatosis - Amyloidosis
- Lupus Nephritis - Lupus Nephritis
Pathophysiology Inflammation and cytokines → capillary damage → Structural damage of filtration barrier → m
● Small protein leakage (GBM negativity - Loss of GBM negativity → selectiv
intact) - Foot process fusion → nonselecti
● Cell leakage → hematuria & leukocyturia - Protein loss surpasses hep
● Inflammation → ↓ GFR → oliguria ↓albumin → ↓oncotic press
○ ↓ urea & creatinine excretion → - ↑ lipid production to compe
Azotemia hipoproteinemia → hyperlip
● ↑albumin PCT reabsorption by Na casts
cotransporter → Na & volume retention (not - Antithrombin III (smallest fa
RAAS) hypercoagulability
○ Hypertension - Loss of Ig → ↑infection
○ Edema - Loss of Vitamin D → hypoc
Proteinuria Adults Adults
● 150 mg - 3.5 gr per day ● ≥ 3.5 gr per day
Children Children
● 4 - 40 mg/m2/h ● ≥ 40 mg/m2/h
Clinical features - Mild, stable edema → pitting - Progressive edema → Due to unde
- Hypertension ○ Overfill: RAAS → ↑Na & vo
- Oliguria ○ Albuminuria → NHE3 antip
- <0.5 mL/kg/h or <400 mL/day & volume retention
- Intermittent gross hematuria & persistent ○ First periorbital, then pitting
microscopic hematuria - Hypertension
- May present uremic symptoms - Hypercoagulability
- Nausea, vomit, CNS abnormalities - Increased infections
- Weight gain
- Hypocalcemia
Laboratory - Hematuria w/ acanthocytes - Hypoalbuminemia
findings - >5 RBCs per HPF - Hyperlipidemia
- Pyuria → may have WBC casts ○ ↑TC, TAG, VLDL, LDL
- Azotemia → ↑BUN - Fatty casts on urinalysis
- RBC casts on urinalysis
Complications - Renal insufficiency → CKD - Thrombosis
- Some → Rapidly progessive - Renal or deep vein thrombo
glomerulonephritis → ESRD - Atherosclerotic state
- Postinfectious GN - Myocardial infarction
- Wegner's granulomatosis - Stroke
- Lupus Nephritis - End-Stage Renal Disease
Etiologies Primary Primary
- IgA Nephropathy / Berger - Minimal Change Disease
- Postinfectious Glomerulonephritis - APSGN - Focal Segmental Glomeruloscleros
- Membranoproliferative Glomerulonephritis - Membranous Nephropathy
Secondary - Membranoproliferative Glomerulon
- Henoch-Schönlen Vasculitis Secondary
- Goodpasture Syndrome - Diabetic Nephropathy
- Wegner's Granulomatosis - Amyloidosis
- Lupus Nephritis - Lupus Nephritis
Pathophysiology Inflammation and cytokines → capillary damage → Structural damage of filtration barrier → m
● Small protein leakage (GBM negativity - Loss of GBM negativity → selectiv
intact) - Foot process fusion → nonselecti
● Cell leakage → hematuria & leukocyturia - Protein loss surpasses hep
● Inflammation → ↓ GFR → oliguria ↓albumin → ↓oncotic press
○ ↓ urea & creatinine excretion → - ↑ lipid production to compe
Azotemia hipoproteinemia → hyperlip
● ↑albumin PCT reabsorption by Na casts
cotransporter → Na & volume retention (not - Antithrombin III (smallest fa
RAAS) hypercoagulability
○ Hypertension - Loss of Ig → ↑infection
○ Edema - Loss of Vitamin D → hypoc
Proteinuria Adults Adults
● 150 mg - 3.5 gr per day ● ≥ 3.5 gr per day
Children Children
● 4 - 40 mg/m2/h ● ≥ 40 mg/m2/h
Clinical features - Mild, stable edema → pitting - Progressive edema → Due to unde
- Hypertension ○ Overfill: RAAS → ↑Na & vo
- Oliguria ○ Albuminuria → NHE3 antip
- <0.5 mL/kg/h or <400 mL/day & volume retention
- Intermittent gross hematuria & persistent ○ First periorbital, then pitting
microscopic hematuria - Hypertension
- May present uremic symptoms - Hypercoagulability
- Nausea, vomit, CNS abnormalities - Increased infections
- Weight gain
- Hypocalcemia
Laboratory - Hematuria w/ acanthocytes - Hypoalbuminemia
findings - >5 RBCs per HPF - Hyperlipidemia
- Pyuria → may have WBC casts ○ ↑TC, TAG, VLDL, LDL
- Azotemia → ↑BUN - Fatty casts on urinalysis
- RBC casts on urinalysis
Complications - Renal insufficiency → CKD - Thrombosis
- Some → Rapidly progessive - Renal or deep vein thrombo
glomerulonephritis → ESRD - Atherosclerotic state
- Postinfectious GN - Myocardial infarction
- Wegner's granulomatosis - Stroke
- Lupus Nephritis - End-Stage Renal Disease
