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Glomerulonephritis

Glomerulonephritis. Michael Pakdaman MS - 3. Glomerulus – Anato / Histo. Nephr I / O tic ????. NephrOtic (PrOtein) 3 Systemic Diseases Diabetes SLE Amyloidosis 1 “membrane” Membranous GN 2 others Minimal Change Focal Segmental. NephrItic (RBC +/-casts) 3 Autoimmune

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Glomerulonephritis

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  1. Glomerulonephritis Michael Pakdaman MS - 3

  2. Glomerulus – Anato / Histo

  3. Nephr I / O tic ????

  4. NephrOtic (PrOtein) 3 Systemic Diseases Diabetes SLE Amyloidosis 1 “membrane” Membranous GN 2 others Minimal Change Focal Segmental NephrItic (RBC +/-casts) 3 Autoimmune Poststrep GN (Type III) IgA Nephropathy (Type III) Goospasture’s (Type II) 1 “membrane” Membranoproliferative 2 others Crescentic Alport’s (collagen IV defect) Nephr I / O tic ????

  5. HypersensitivityEssentials of GN • Type I – IgE cross-linking on presensitizes mast cells  inflammatory mediators released • Type II – Antibodies directed against specific “enemies.” Damage cells via complement mediated “MAC” Inflammatory response NOT necessarily present • Type III – Immune complex deposits (eg SLE)  activates complement  C5a chemotactic to neutrophils  damage • Type IV – T-cell mediated

  6. NephrOtic • Membranous (#1)– Type III HS • Immune deposits IN the GBM • Assoc w/ hepatitis B antigenemia, autoimmune diseases, thyroiditis, malignancies, pharm (gold, penicillamine, captopril, NSAIDs). • Minimal Change Disease (#1 Kids) • “lipoid nephrosis (why???)” • Tx w/ steroids • Focal Segmental Glomerulosclerosis • Presents w/ acute onset; Glomerular “scarring” • Mutliple etiology: Podocyte injury, Nephron loss, Renal vasodilatation (diabetic nephropathy, sickle cell, obesity, Von Gierke’s, Pregnancy, Obesity, Healing of prior inflammatory injury)

  7. NephrOtic – Systemic Disease • Diabetes – (1) GBM thickening, (2) KW Nodules, (3) DIFFUSE glomerular sclerosis • SLE (Type III) – SubENDOthelial deposits • Amyloidosis “apple green”

  8. NephrItic – Autoimmune • Poststrep GN (#1 acute) – type III (“small” – subepithelial “humps”) – follows sore throat or cellulitis • Peripheral & periorbital edema (autoimmune) • IgA – post-infectious – type III • Mild, self-limiting, assoc w/ Henoch-Sch • Goodpastures – type II • Men in mid 20’s

  9. NephrItic – Other 3 • Membranoproliferative – MESANGIAL CELLS proliferate. Assoc w/ Hep C, SLE, a1-antitrypsin. • Crescentic GN – Fibrin deposition in Bowman’s. Assoc w/ post-strep & membranous GN. • Alport’s – Hereditary, type IV collagen defect, CN VIII defective

  10. Membranoproliferative“tram-tracking”

  11. Linear – Type II Goodpasture’s(anti-GBM)Capillary BM of glomerulus & alveolar walls

  12. Granular – Type III IgA Nephropathy(mesangial deposits)Post-Strep GN(Subepithelial)Membranous GN(deposits are in the GBM)SLE GN(Subendothelial)Colon CA (anti-CEA deposits)

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