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primitifs et secundaires
Les glomerulonephrite
croniques
Les glomerulonephrites croniques
primitifs sont un groupe de
nephropaties dans lesquelles la
principale afection est represente
par un procesus inflamatoire
cronique glomerulaire d’etiologie
inconnue.
Les glomerulonephrites cronique
(GNC) primitifs represent 70 - 80%
des toutes GNC et sont definis par le
“sindrome nephritique cronique”.
Le tableau clinique dans la
glomerulonephrite cronique peut
etre divers sous la forme de :
Le sindrome nephritique cronique
Le sindrome nephrotique ou
L`anomalies urinaires asimptomatique.
– L`analise de rutine de l`urine,
Avec mise en evidence fortuite d’une croisance
de l`uree et/ou creatinine, acompagnee d’une
grade d’anemie dans les investigations
biochimiques
L`aspect macroscopique de
GNC
Clasiffication de
glomerulonephrites croniques
A. Le GNC PRIMITIF- clasiffication
morfologique
– GN avec lesions glomerulaires minimes
– Glomerulosclerose focale et segmentaire avec
hialinose
GN membraneux(extra-membraneux)
– GN proliferatif mesangiale
Avec des depots de Ig A
Avec des depots de Ig M et/au C3
„ IgG et/au C3
Sans depots de Ig G et C3
GN mesangio-capilaire
GN avec lesions inclassable
B. GNC SECONDAIRE (Glassock R)
Clasification de GNC secondaire
1.l`afectation glomerulaire en maladies polisistemique:
Colagenose: Lupus eritematos systémique, sclerodermie,
dermatomiosite
– Le purpura rhumatoide Schönlein –Henoch
– Le syndrome Goodpasture
– Les vasculites sistemique necrosante
2. GNC de dis/paraproteinemies
– La crioglobulinemie
– La macroglobulinemie Waldenström
– La gamapatia monoclonale benigne
– L`amiloidose
3. GNC secundaire de certains maladies hepatiques:
– De la hepatite cronique avec HVB
– De la hepatite cronique autoimune
– De la cirrhose hepatique
La classification de GNC
secondaire
4.GN des maladies infectieuse
– GNC poststreptococcique/ nestreptococcique
– L`endocardite infectieuse
– Le nephrite avec de shunt
– La protozoaire et autres infections parasitaire
– La infections virales (HIV, HVB)
5.GN de neoplasies, limphomes
6. GN dans les maladies heredo- familiales
– La glomerulosclerose diabetique
– Sindrome Alport
– Le sindrome nephrotique congenital
– Drepanocitose
– Autres
7. GN secondaire aux medicamentes, imunisation,
allergenes
La glomerulonephrite avec des lesions
glomerulaires minimes
Les synonimes:la nephrose lipoidique, le
syndrome nephrotique pure avec des glomerules
optique normals, les maladies avec des lesions
minimes.
Dans la microscopie
electronique il e decrit
l`estompation des proceses
podocitares des celules
epitheliales viscerales, elle
donne l`impresion de la
fusionnement des proceses
podocitaires (pedicele).
La glomerulonephrite
secondaire au diabete sucree
Est une complication importante qui evolue en
temp aux patients avec le diabet sucre(DS), il y
a la forme de complication microvasculaire plus
importante.
Apare atât in DZ tip 1, insulinodependent în 30-
40% din cazuri cât şi in DZ de tip 2 în 20-30%
dintre cazuri.
La nephropatie diabetique est la premiere cause
de IRC dans les pays devellopes
anemie
atc anti-
phospholipides
GN avec semilunes
– However, it may not be enough if used alone for the treatment of advanced
forms of lupus nephritis.
– How is it given?
– What are the possible side effects? This medication in general is well-
tolerated but there are several possible side effects.
Vision problems: It is important for patients taking this medication to undergo yearly
eye exams
Severe anemia (low blood count): Individuals should be tested for a condition called
G-6-PD deficiency before starting this medicine. If a person with this condition takes this
medicine, it can cause a reaction that results in a massive breakdown of red blood cells.
GI: abdominal cramps and/or diarrhea
Liver problems: Rare: liver function tests at least twice a year
Immunosuppressive Drugs:
cyclophosphamide,
cyclosporine,
tacrolimus,
azathioprine,
mycophenolate mofetil
Rituximab
Drugs that reduce the immune system's tendency
to attack itself.
These drugs are typically reserved for individuals
with lupus and severe organ involvement.
!!!!! Lupus that involves the kidney, brain, or
significant arthritis may require this drug.
Cyclophosphamide
Cyclophosphamide reduces the ability of the immune system to
induce inflammation . It is considered a type of chemotherapy.
How is it given? It can be given by mouth as a pill daily for
several months or by once or twice monthly for 3-6 months.
There is good data to support that it is just as effective if given by
mouth as by IV. If given orally however, the overall exposure to
this medicine is much greater. Therefore it could possibly be
associated with more side effects.
What are the possible side effects?
Leucopenie
Low blood count
Low platelets (needed to help stop and prevent bleeding)
Cistita hemoragica
Serious Infections
Increased risk of cancer in the future
Medication Imunoreglatoire
Cyclosporine/tacrolimus (Gengraf®, Sandimmune®,
Prograf®)
– How does it work? These drugs block the effect of T-cells
which are an important type of white blood cell in the immune
system.
– How is it given? It is given orally as a pill or liquid
– What are the possible side effects?
Having too few white blood cells-important to fight infections
Low blood count
Nervous system: Some individuals can experience headaches,
tingling or numbness in the fingers or toes. In severe cases,
seizures can occur if there is too much medicine in the body. All of
these symptoms should be reported immediately to the doctor.
Dental: Some individuals may notice swelling of the gums. This
may be more common in people who are taking a specific type of
blood pressure medicine called a calcium channel blocker at the
same time.
Hair growth: This medicine can cause excessive hair growth on
different parts of the body
Autres imunosupresoare
Azathioprine/mycophenolate mofetil [MMF]
(Imuran®, Cellcept®, Myfortic®)
– Comme il fonctionne? Cette medicamentes empêche
la production de leucocites dans le systeme .
– Comme est donne? Est donne oral come une pilule ou
liquide
– Quelle sont le posible effets avers?
Hematocrite faible
Systeme imunitaire basse parce que les leucocites sont
quelle que lutte contre l`infections
GI malaise: plus de MMF (diarrhe et estomac crampes)