1. II) Acute GN Definition (Hricik et al, 1998) Syndrome characterized by the abrupt onset of macroscopic hematuria; oliguria; acute renal failure; manifested by a sudden decrease in GFR; and fluid retention, manifested by edema and hypertension. Definition (Hricik et al, 1998) Syndrome characterized by the abrupt onset of macroscopic hematuria; oliguria; acute renal failure; manifested by a sudden decrease in GFR; and fluid retention, manifested by edema and hypertension.

2. Acute GN Classically post-streptococcal although other infectious etiologies possible Acute pharyngitis followed 10-14 d later by acute nephritis (sodium and water retention, hypertension, smoky coloured urine, fall in GFR Usually associated with low complement Treatment is supportive Prognosis generally good with spontaneous resolution Classically post-streptococcal although other infectious etiologies possible Acute pharyngitis followed 10-14 d later by acute nephritis (sodium and water retention, hypertension, smoky coloured urine, fall in GFR Usually associated with low complement Treatment is supportive Prognosis generally good with spontaneous resolution

3. III) Nephrotic Syndrome Case 79 year old man, history of ureteric stenosis requiring stenting 8 years ago New onset edema, HTN 24 hour urine – 13 g protein, cholesterol 11, creatinine 135 Diagnosis?Case 79 year old man, history of ureteric stenosis requiring stenting 8 years ago New onset edema, HTN 24 hour urine – 13 g protein, cholesterol 11, creatinine 135 Diagnosis?

4. ProteinuriaProteinuria Mechanisms Damage to glomerular BM/visceral epithelium Impaired reabsorption by tubular cells Secretion of protein from tubular cells Filtration of an abnormal protein that is smallMechanisms Damage to glomerular BM/visceral epithelium Impaired reabsorption by tubular cells Secretion of protein from tubular cells Filtration of an abnormal protein that is small

5. Nephrotic Syndrome

7. Definition (Screiner, 1971) proteinuria edemahypoalbuminemia hyperlipidemiaA clinical entity having multiple causes and characterized by increased glomerular permeability manifested by massive proteinuria and lipiduria. There is a variable tendency towards edema, hypoalbuminemia and hyperlipidemia. Protein excretion rates are usually in excess of 3.5 g/day/1.73m 2 body surface in the absence of a depressed GFR. Definition (Screiner, 1971) proteinuria edemahypoalbuminemia hyperlipidemiaA clinical entity having multiple causes and characterized by increased glomerular permeability manifested by massive proteinuria and lipiduria. There is a variable tendency towards edema, hypoalbuminemia and hyperlipidemia. Protein excretion rates are usually in excess of 3.5 g/day/1.73m 2 body surface in the absence of a depressed GFR.

8. Nephrotic Syndrome Differential Diagnosis Minimal change FSGS Membranous MPGN IgA nodular – amyloidosis, DM, fibrillary Differential Diagnosis Minimal change FSGS Membranous MPGN IgA nodular – amyloidosis, DM, fibrillary

9. Nephrotic Syndrome

10. Minimal Change Disease

11. FSGSFSGS

12. Membranous Nephropathy