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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

slide2
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.
slide4
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.
slide8
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:
  • Chemical change in the glomerular basement membrane causing protein loss.
slide11
* 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).
slide14
* 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.
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…...
slide23
* IF (Immunoflurescence):
  • Deposition of IgG and C3.
slide25
* 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.
slide29
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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