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Glomerulonephritis. By Dr. Abdelaty Shawky Assistant professor of pathology. Glomerular diseases constitute one of the major problems in nephrology; indeed, chronic glomerulonephritis is one of the most common causes of chronic renal failure in humans.

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Glomerulonephritis

Glomerulonephritis

By

Dr. Abdelaty Shawky

Assistant professor of pathology


  • Glomerular diseases constitute one of the major problems in nephrology; indeed, chronic glomerulonephritis is one of the most common causes of chronic renal failure in humans.


Classification of glomerular diseases
* Classification of glomerular diseases:

I. Primary G.N (the disease affects kidney only):

  • Minimal change glomerular disease (Lipoid nephrosis).

  • Acute diffuse proliferative G.N:

    • Post-streptococcal G.N.

    • Non-post-streptococcal GN.

  • Rapidly progressive G.N.

  • MembraneousG.N.

  • MembranoproliferativeG.N.

  • Chronic G.N.


II. Secondary G.N (the disease affects kidney and other organs):

  • Systemic lupus erythematosus (SLE).

  • Polyarteritisnodosa (PAN).

  • Wegener granulomatosis.

  • Diabetes mellitus (diabeteic nephropathy).

  • Goodpasture syndrome.

  • Amyloidosis.



  • Most of the 1ry glomerular disease are due to immunologic mechanisms.

  • To study any glomerular disease, a renal biopsy is taken and examined by 3 types of microscopes:

    1. Light microscope: to examine the structure of glomeruli, tubules and interstitium.

    2. IF (immune flourescentmicroscope): to detect the type of deposited immunoglobulin in the glomeruli.

    3. EM (electron microscope): to detect the site of immune complex, either sub-epithelial, sub-endothelial, mesangial or basement membrane..



Etiology pathogenesis
*Etiology & pathogenesis: mechanisms.

  • Chemical change in the glomerular basement membrane causing protein loss.


* mechanisms.Grossly:

  • Mild bilateral kidney enlargement.

    * LM (Light microscope):

  • No abnormalities.

    * IF (Immunoflurescence):

  • No immune deposits.

    * EM (Electron microscope):

  • Fusion of the foot processes of the epithelial cells (podocytes).




* CP (Clinical picture mechanisms.):

  • Affect children and young adults.

  • Cause nephrotic syndrome.

    * Fate:

  • The disease has excellent prognosis and most patients respond to corticosteroids with complete resolution of proteinuria.



Etiology pathogenesis1
*Etiology & pathogenesis: mechanisms.

  • Immune complex reaction; (nephrotegenic strains of group A beta haemolytic streptococci + Ig G), the complex is deposited in the glomeruli with subsequent complement activation  acute inflammation.


Grossly
* mechanisms.Grossly:

  • Mild bilateral kidney enlargement with petechial hemorrhages.


Lm light microscope
* LM (Light microscope mechanisms.):

a. Glomeruli:

  • Proliferation of endothelial and mesangial cells.

  • Glomerular capillaries contain neutrophils.

  • Bowman’s space shows: neutrophils, RBCs, some albumin.

    b. Tubules:

  • The lining cells are swollen.

  • The lumens show casts (RBCs casts, neutrophil casts & hyaline casts).

    c. Interstitium:

  • Acute inflammatory reaction…...


Normal kidney
Normal kidney mechanisms.


Normal kidney1
Normal kidney mechanisms.




* IF ( mechanisms.Immunoflurescence):

  • Deposition of IgG and C3.


Positive ig g and c3
Positive mechanisms.Ig G and C3


* EM (Electron microscope): mechanisms.

  • Subepithelial immune complex deposit (humps).


Cp clinical picture
* CP (Clinical picture mechanisms.):

  • A young child presents with oliguria, hematuria (cocoa-colored urine) and peri-orbital edema about 2 weeks after recovery from a sore throat.



  • More than 95% of mechanisms.the affected children eventually recover totally with treatment.

  • A small minority of children (perhaps less than 1%) do not improve, become severely oliguric, and develop a rapidly progressive glomerulonephritis.

  • Some of the remaining patients may undergo slow progression to chronic glomerulonephritis.


Nephritic syndrome
Nephritic syndrome mechanisms.

- A syndrome formed of:

1. Haematuria.

2. Oliguria.

3. Peri-orbital oedema.

4. Hypertension.

- The most common cause of nephritic syndrome in children is post-streptococcal GN.


Nephrotic syndrome
Nephrotic mechanisms. syndrome

- A syndrome formed of:

1. Hypoproteinaemia.

2. Proteinuria .

3. Oedema.

4. Hypercholesterolaemia.

  • The most common cause of nephrotic syndrome in children is minimal change glomerular disease.

  • The most common cause of nephrotic syndrome in adults is membranous GN.


Thanks
Thanks mechanisms.

References:

Robbins and Cotran’s: Pathologic Basis of Disease. Seventh edition.


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