Pediatric Glomerulonephritis

by Brian Alverson, MD

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    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.

    About the Lecture

    The lecture Pediatric Glomerulonephritis by Brian Alverson, MD is from the course Pediatric Nephrology and Urology. It contains the following chapters:

    • Glomerulonephritis
    • Acute Glomerulonephritis
    • Chronic Glomerulonephritis

    Included Quiz Questions

    1. Poststreptococcal glomerulonephritis (PSGN)
    2. Pyelonephritis
    3. IgA nephropathy
    4. Lupus nephritis
    5. Membranoproliferative glomerulonephritis (MPGN)
    1. Henoch-Schonlein purpura
    2. IgA nephropathy
    3. Minimal change disease
    4. Membranoproliferative glomerulonephritis
    5. Membranous nephropathy
    1. Focal segmental glomerulosclerosis
    2. Poststreptococcal glomerulonephritis
    3. Henoch-Schonlein purpura
    4. Hemolytic uremic syndrome
    1. Systemic lupus erythematosus
    2. Poststreptococcal glomerulonephritis
    3. Hemolytic uremic syndrome
    4. Henoch-Schonlein purpura
    5. IgA nephritis

    Author of lecture Pediatric Glomerulonephritis

     Brian Alverson, MD

    Brian Alverson, MD

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    Excellent lecture
    By Jalil Z. on 26. July 2020 for Pediatric Glomerulonephritis

    Excellent lecture. Nephrology is a topic that is often obscured by the teachers in this field I met. This is not the case in this lecture. Let there be light ;)