Haematuria, Nephrotic, and Nephritic Syndromes PDF

Haematuria, nephrotic and nephritic syndromes Lecture Number 7.1 Status Done Type Lecture 7.1 Haematuria, nephrotic and nephritic syndromes Overview This lecture discusses haematuria, nephrotic syndrome, and nephritic syndrome, emphasizing their definitions, c...

Haematuria, nephrotic and nephritic syndromes Lecture Number 7.1 Status Done Type Lecture 7.1 Haematuria, nephrotic and nephritic syndromes Overview This lecture discusses haematuria, nephrotic syndrome, and nephritic syndrome, emphasizing their definitions, classifications, and pathophysiological distinctions. Haematuria is categorized into microscopic and macroscopic types, with diagnostic steps to distinguish true haematuria from pseudohaematuria, which includes urine discoloration without red blood cells (RBCs). Nephrotic and nephritic syndromes are explored through their differing impacts on proteinuria, glomerular filtration, and systemic symptoms, with a focus on how these factors inform clinical management. Understanding these conditions aids in early diagnosis, identification of disease origins, and implementation of targeted treatment to reduce renal and systemic complications. Learning Objectives Objective 1: Define and classify haematuria, differentiating true haematuria from pseudohaematuria and identifying sources (e.g., glomerular vs. non-glomerular). Objective 2: Define and classify proteinuria, including the pathophysiology of glomerular, tubular, and overflow proteinuria. Objective 3: Differentiate between nephrotic and nephritic syndromes, focusing on their clinical presentations, pathophysiology, and implications for diagnosis and treatment. Key Concepts and Definitions Haematuria: Presence of red blood cells (RBCs) in the urine, often indicating renal or urogenital pathology. Microhaematuria: ≥3 RBCs per high-power field, visible only under a microscope. Common in glomerular diseases, e.g., IgA nephropathy. Macrohematuria: Blood visible to the naked eye in the urine. Distinguish from pseudohaematuria through microscopy. Pseudohaematuria: Discoloured urine without RBCs, caused by factors like: Diet: Foods such as beetroot or carrots. Drugs: Rifampicin and other medications. Haematological Disorders: Myoglobinuria, haemoglobinuria. Contamination : Menstrual or postpartum blood, especially in females. Proteinuria: Elevated protein levels in the urine, a key indicator of renal disease. Glomerular Proteinuria: Due to glomerular barrier damage (e.g., podocytes or basement membrane), resulting in heavy albumin leakage. Tubular Proteinuria: Caused by tubular dysfunction, leading to failure to reabsorb small proteins (e.g., beta-2 microglobulin). Overflow Proteinuria: Excessive low-molecular-weight proteins from conditions like multiple myeloma overwhelm tubular reabsorption. Functional Proteinuria: Benign, transient proteinuria due to factors like fever or exercise. Nephrotic Syndrome: Marked by significant proteinuria (>3.5 g/day), hypoalbuminemia, oedema, and hyperlipidaemia. Indicates damage to the glomerular filtration barrier. Nephritic Syndrome: Characterized by haematuria, reduced glomerular filtration rate (GFR), non-nephrotic proteinuria  (500 mg/day indicate glomerular disease. Non-Glomerular Origin : Blood enters from areas outside the glomeruli (e.g., urinary tract infections or kidney stones), resulting in pink to red urine with isomorphic RBCs, proteinuria