- Difference between APSGN and nephrotic syndrome.

Difference between APSGN and nephrotic syndrome.

	APSGN	N.S
clinical
Strept infection	+ve	-ve
Edema	minimal	massive
HTN	++	Rare,transient
Oliguria	marked	During edema
Hematuria	++	Rare , transient
Laboratory
S.albumin	Normal	low
S.cholsterol	normal	high
C3	low	normal
ASO	Usually +ve	-ve
Proteinuria	minimal	heavy
Casts	Red & granular	hyaline
Renal function	Impaired	Usually normal

- Pathogenesis of Acute Post streptococcal Glomerulonephritis (APSGN).

Pathogenesis of Acute Post streptococcal Glomerulonephritis (APSGN).

Evidence of immune mechanism: 

1. Latent period between strept infection and onset of the disease
2. ↓Serum C3
3. Detection of immune reactants in glomeruli by immunologic techniques 

By Ibrahim samaha

- Causes of Hematuria in Children.

 Causes of Hematuria in Children

UPPER URINARY TRACT DISEASE
Isolated renal disease

• Immunoglobulin (Ig) A nephropathy (Berger disease)
• Alport syndrome (hereditary nephritis)
• Thin glomerular basement membrane nephropathy
• Postinfectious GN (poststreptococcal GN)*
• Membranous nephropathy
• Membranoproliferative GN*
• Rapidly progressive GN
• Focal segmental glomerulosclerosis
• Anti–glomerular basement membrane disease

Multisystem disease

• Systemic lupus erythematosus nephritis*
• Henoch-Schönlein purpura nephritis
• Granulomatosis with polyangiitis (formerly Wegener granulomatosis)
• Polyarteritis nodosa
• Goodpasture syndrome
• Hemolytic-uremic syndrome
• Sickle cell glomerulopathy
• HIV nephropathy

- Urine analysis Differentiation between Golmeular and Non-Glomerular hematuria

 Urine analysis Differentiation between

 Golmeular and Non-Glomerular hematuria

	Golmeular	Non-Glomerular
Colour	brown, smoky, cola-colored, or tea-colored as a result of the hematin formation from hemoglobin in the acidic environment.	bright red or pink
RBCs morphology	Dysmorphic > 80% Acanthocytes > 5%	Normal
proteinuria	>100 mg/dL via dipstick,	minimal proteinuria on dipstick (<100 mg/dL).
Clots	Absent	May be Present
RBCs cast	May be present due to squeezing of RBCs and sticking together and entangled in the protein matrix	Absent
Pain	Painless	Painful

- Multifactorial inheritance (polygenic inheritance).

Multifactorial inheritance (polygenic inheritance)

 

Result from the interplay of genetic and environmental factors.

There is a similar rate of recurrence among all 1st-degree relatives (parents, siblings, offspring of the affected child). It is unusual to find a substantial increase in risk for relatives related more distantly than 2nd degree to the index case.

The magnitude of the trait is determined by number of genes (each adding a small amount to the quantity of the trait or subtracting a small from it)

Also number of environmental factors each act by adding or subtracting an amount to final result. 

Conditions often associated with multifactorial inheritance:

Congenital malformations:

•      neural tube defects

•      congenital heart disease

•      cleft lip and palate

•      pyloric stenosis

•      developmental dysplasia of the hip (DDH)

•      talipes equinovarus

•      hypospadias

- Factors affecting gene expression (in AD disorders)

Factors affecting gene expression

 

 (in Autosomal dominant disorders)

1.     Pleiotropy

2.     Variable expressivity

3.     Reduced penetrance

4.     New mutations

5.     Homozygosity

6.     Knudson two-hit hypothesis

Pleiotropy

·        A single gene (AD) that may give rise to ≥ 2 apparently unrelated effects.

·        In tuberous scelerosis, some affected individuals may have all features (learning difficulties, epilepsy, facial rashes,…)

·        Pleiotropy can result from different mutations in the same gene

·        AD traits may involve only one organ of the body i.e. the eye in congenital cataract. 

Variable expressivity  

·        Striking variation in the clinical features of AD disordes from person to person , even in the same family.

·        In AD polycystic kidney disease, some affected individuals develop renal failure in early adulthood whilst others have just a few renal cysts without affection of renal function.

Reduced Penetrance

·        Penetrance describes the frequency with which phenotypic manifestation of a gene are expressed.

·        A highly penetrant gene (100% penetrance) will express itself almost regardless of the effect of the environment or other interacting gene.

·        This phenomenon explains apparent skipped generations in certain pedigrees.

·        Reduced penetrance when the gene produces characteristic features much less often.

Factors Affecting Penetrance:

1.     Modifier genes.

2.     Hormonal/ reproductive factors.

3.     Response to DNA damage.

4.     Carcinogens (Not everyone with an altered gene develops cancer).