So let’s focus on what’s happening
when we have an abnormal glomerulus
and in particular, inflammation of the
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 is
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
maybe either primary,
something wrong with the kidney,
or secondary, something
And in this case often, they
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
This is the one which often
presents with red blood casts.
We have primary and secondary causes.
The primary causes include commonly
Remember, that treatment of
strep throat does not prevent
like it does rheumatic fever.
It could be an infectious glomerulonephritis,
basically a pyelonephritis,
or it could be IgA nephropathy which
is also called Berger’s disease.
IgA nephropathy is the number one cause
of acute glomerulonephritis
in children worldwide
or it could be membranoproliferative
glomerulonephritis or MPGN.
Secondary causes of acute
glomerulonephritis are systemic problems
that will acutely cause
the kidneys to bleed.
The most common is
Also, lupus can do it
or patients may have polyarteritis nodosa
which 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 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
Patients may have
They could have focal
or they may have mesangial
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 longstanding
renal disease, obviously lupus,
polyarteritis nodosa, HUS, subacute
endocarditis and Goodpasture syndrome.
This can all be
So the diagnosis of glomerulonephritis,
if you suspect it,
is not always made by a biopsy.
We do not require biopsy in patients where
there is clear explanation for the disease.
Examples would be post-strep
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 diseases,
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 normal
C4 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-strep glomerulonephritis
just a low C3.
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.
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
That’s a summary of hematuria
Thanks for your attention.