Glomerulonephritis
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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


Glomerulonephritis

  • 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.


Glomerulonephritis

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.


Normal glomerulus

Normal Glomerulus


Glomerulonephritis

  • 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..


Minimal change glomerular disease

Minimal change glomerular disease


Etiology pathogenesis

*Etiology & pathogenesis:

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


Glomerulonephritis

* 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).


Em of normal glomerulus

EM of normal glomerulus


Em of minimal change glom disease

EM of minimal change glom. disease


Glomerulonephritis

* CP (Clinical picture):

  • 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.


Post streptococcal g n

Post-streptococcal G.N


Etiology pathogenesis1

*Etiology & pathogenesis:

  • 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

* Grossly:

  • Mild bilateral kidney enlargement with petechial hemorrhages.


Lm light microscope

* LM (Light microscope):

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


Normal kidney1

Normal kidney


Post streptococcal gn

Post-streptococcal GN


Post streptococcal gn1

Post-streptococcal GN


Glomerulonephritis

* IF (Immunoflurescence):

  • Deposition of IgG and C3.


Positive ig g and c3

Positive Ig G and C3


Glomerulonephritis

* EM (Electron microscope):

  • Subepithelial immune complex deposit (humps).


Cp clinical picture

* CP (Clinical picture):

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


Rbcs cast

Hematuria (coca cola colored urine)

RBCs cast


Glomerulonephritis

  • More than 95% of 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

- 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 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

References:

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


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