Acute Glomerulonephritis

The term acute glomerulonephritis is used by clinicians as well as pathologists to describe the sudden onset of kidney disease. Irrespective of the cause, there would be enlargement of a kidney or kidneys and the capsule around the kidney is strained and stretched. Ultrasonography is always helpful to ascertain the size of kidneys. Histological examination of kidney biopsy would present densely cellular glomerular tuft with polymorphonuclear cells (a type of white blood cells) in the glomerular capillaries. Accumulation of leukocytes (white blood cells) in the glomerular capillaries with swelling and proliferation of the vascular endothelium (inner lining of capillaries) is rapidly followed by edema (swelling) and mesangial proliferation (enlargement of inner stalk of a cluster of glomerular capillaries)leading to capillary ischemia (poor blood supply).

The glomerular basement membrane (GBM) is the other important component affected by acute glomerulonephritis. By electron microscopic study of kidney biopsy, electron dense deposits of antigen-antibody complexes could be revealed in and around the glomerular basement membrane. The ultrastructural features of normal GBM have been depicted in the figure-1 and the figure-2 is from a case affected by acute glomerulonephritis.

Figure-1: Electron micrograph of a capillary loop of glomerular tuft showing normal features; CL: capillary lumen, US; urinary space, En: endothelium, GBM: glomerular basement membrane, EpC: epithelial cell or podocyte.

Figure-2: Electron micrograph of a capillary loop of glomerular tuft from a case affected by acute glomerulonephritis is showing sub-epithelial deposits; CL: capillary lumen, US; urinary space, GBM: glomerular basement membrane, dep: deposits on sub-epithelial site of GBM.

The tubules in the kidney may show slight degenerative changes. The degree of degenerative changes in the tubules depends on the extent of the glomerular obstruction. The interstitial tissue and the blood vessels are observed to be normal on the histological study of kidney biopsy.

The Mind and Brain: Functions and Physiology

The most important fact is that the brain is the organ of the mind and the mind is like the software of a computer. The mental functions are related to the cerebral cortex of the brain. In humans the cerebral cortex is better developed than the inferior animals. Our sense organs are like input devices of a computer. Our brain processes and stores the data in encapsulated form with respect to attributes. Our ears transmit sound signals to our brain, which are analyzed by our mind and classified as noise, vocal audio and music. Music files are further categorized as per specific attributes and stored in our brain. Whenever we listen to the same sound again we could easily name a person as per tonal quality of voice, instrument as per the pitch and rhythm of the music and the birds and animals as per their specific vocal attributes. Human mind is capable of distinguishing a variety of fragrances and odors, human faces and pictures, fonts and shapes, smooth and rough surfaces, bitter, sweet or sour tastes etc. Expressions of thoughts and emotions are special functions of our mind.

The brain, like other organs is powered by chemicals. Whenever the chemistry of brain is disturbed, mental symptoms are an early result. The glucose and oxygen have a vital role in the physiology and bio-energy generation of our body. The anoxia (low oxygen supply) of airmen and in the early stages of anesthesia may lead to chock. The hypoglycemia in diabetics on insulin therapy has been known to cause insulin shock or hypoglycemic shock. Certain groups of chemicals or drugs can cause mental disturbance and there are other chemicals or drugs which are capable of improving the mental function. For example hallucinogens like LSD disturb the mental functioning of normal people whereas tranquilizers and psychic energizers are known to improve the mental functioning of abnormal people. Except the numerical ability, the human mind and brain are faster than any computer in answering a variety of questions related to memory and experiences. Till date no computer could store the attributes of taste, smell, feelings and emotions. The super programming and coding of our mind is updated every moment through our observation and experience.

Azotemic or Hydropic Glomerulonephritis

The high concentration of non protein nitrogen (NPN) in the blood of a patient, mainly due to elevated level of urea is termed as azotemia. Elevated level of urea in blood is termed as uremia and it may be due to renal abnormality or due to other health problems like dehydration and excessive burns on the body. The glomerulonephritis (inflammation of glomeruli of kidneys) may be azotemic or hydropic type depending on the nature of glomerular lesions. There may be marked narrowing of the glomerular capillaries leading to azotemia with renal insufficiency and hypertension. On the other hand the status of glomerular capillaries may remain normal but there could be an increase in the permeability of glomerular basement membrane (GBM), the filtration barrier of kidneys. The clinical picture would be hydropic (accumulation of water in the tissues of the body) in character. The hydropic glomerulonephritis is clinically represented with edema associated with hypoproteinemia (low level of protein in blood) and hyperlipemia (high concentration of lipids or cholesterol in blood).

A child or an adult affected with fever or some other acute disease finds the increase in the daily output of urine. There may be tinge of blood in the urine of the patient affected by glomerulonephritis. Sudden appearance of features like puffiness or swelling on face (facial edema), ankles and hands after any acute disease needs expert medical attention and medication. The urine of such patients would show notable excretion of albumin. The patient may be less perspiring with dry skin. The pulse could be full and hard. The loin pain and a feeling of heaviness in the lower abdominal region are the associated symptoms. The polyuria (excessive output of urine) is probably compensatory action of affected kidneys to flush out solid wastes of metabolism form the body. An effective therapy would definitely reverse the associated symptoms and lesions.

Happy New Year - 2009

Let us pray for the Peace, Happiness and Prosperity throughout the World. Let God decorate every ray of the sun reaching you with the fragrance of success and prosperity for you. Keep smiling and rocking in 2K9. Wish you a “Very Happy New Year” Dr. Rayat

How Hypertension Is Related To Kidney

High blood pressure or hypertension is one of the most characteristic phenomenon of chronic glomerulonephritis. It is evident that renal lesions (pathological abnormality in kidney) of an ischemic kidney (kidney with poor blood supply) may cause hypertension. This has been seen in the secondary hypertension which develops in the course of glomerulonephritis. Mechanical as well as pathological compression of renal parenchyma has been found to cause hypertension in experimental animals. Chronic pyelonephritis may also cause hypertension.

A variety of renal disorders (kidney diseases) may give rise to hypertension. The kidney disease may be parenchymal or of vascular origin primarily. Morbid anatomical studies have revealed that partial occluding of even one of the renal arteries due to intimal thickening (thickening of internal lining of artery) could be a cause of hypertension due to renal involvement. The vascular or presser substance can be formed by an ischemic kidney. Healthy kidneys are capable of eliminating any presser substance formed in the system. The circulating presser substance is called hypertensin or angiotonin. The angiotonin is formed in the blood by the interaction of an enzyme, renin, secreted by ischemic kidney. The maintenance of normal blood pressure depends on a correct balance between the production of a presser material by the adrenal cortex and its removal by the kidneys. The hypertension may be the result of over-activity of the adrenal gland or some renal disorder.

The primary hypertension and the renal hypertension could be ruled out by the family physician of the patient. In the primary hypertension, the high blood pressure develops early without any renal insufficiency, but in glomerulonephritis, the hypertension develops gradually with renal insufficiency and anemia (fall in hemoglobin level in blood). However, if the patient is seen only after the development of uremia (high level of urea in blood) making distinction between the primary or secondary hypertension could be difficult.