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Today is the First Day,Today is the First Day,
of Rest of Your Life...!of Rest of Your Life...!
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Normal Kidney:
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Normal Glomerulus (PAS)
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Filtration Unit:1. Fenestrated Endothelium2. Lamina Rara
Interna. Lamina Rara Densa!. Lamina Rara E"terna#. Podocytes $ Slit
mem%rane
Capillary Lumen
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Glomerular Filtration:
L.R.IL.D.L.R.E
Foot Process
Podocyte
&Visceral e'ithelium(
)*M)*M
)lomerular +a'illary Lumen)lomerular +a'illary Lumen
*o,man-s +a'sule S'ace*o,man-s +a'sule S'ace
*LD*LD
ProteinsProteins./nm03M./nm03M
44
Plasma 5Plasma 5
ProteinsProteins
FIL6R76EFIL6R76E
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Pathogenesis:
Immune mechanisms !ost common
Autoimmune
Planted Antigen Immune comple"#
$o"ins
!eta%olic
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Glomerular diseases:
Primary )89 • Acute Diffuse Prol.
Poststrept & other Inf.• Crescentic (api!ly
Pro"ressi#e$
• %emranous G'.• Lipoi! %inimal Chan"e .• )ocal se"mental
G.sclerosis.• %emranoproliferati#e G'.• I"A nephropathy.• Chronic
I!iopathic G'.
7ssociated ,ith SystemicDiseases9
• *LE+ Diaetes%ellitus.• Goo!pasture,s *yn!rome.• Polyarteritis
'o!osa.
• -e"ener,s Granulomatosis.• enoch/*chonlein Purpura.• 0acterial
En!ocar!itis.• Amyloi!osis • :ereditary Disorders9• Alport,s
*yn!rome.• )ary,s Disease
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Pathogenesis of Immune GN:
A%' AgA% or Immune comple" deposition#
# Immune reaction
*# Inflammation Acti+ation of complement
,# destruction of glomerular structure
-# .enal dysfunction' Proteinuria' /ematuria
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Immune Glomerulonephritis:
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Glomerular damage 0 patterns:
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Immune Glomerulonephritis:
+.Immune +om'le" 786I5)*M :E;M788
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2linical Syndromes:
Nephritic syndrome# 7liguria' /aematuria' Proteinuria'
7edema#
Nephrotic syndrome#
Gross proteinuria' hyperlipidemia'
Acute renal failure (.PGN)#
7liguria' loss of Kidney function 0 8ithin 8ee9s
2hronic renal failure#
7+er months and years 0 Uremia
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Nephritic Syndromes :
4iffuse Proliferati+e GN4iffuse Proliferati+e GN Post
Streptococcal#
.apidly Progressi+e GN (or 2rescentic).apidly Progressi+e GN (or
2rescentic)
Post Streptococcal' Goodpastures'
Focal GlomerulonephritisFocal Glomerulonephritis
Primary: 1ergers disease (IgA Nephritis)
Secondary IgA nephritis' /enoch Schonlein
purpura' S13' 2oeliac 4isease etc#
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Post Streptococcal GN(Prol#GN):&0, 8ee9s follo8ing
streptococcal infection
(nephritogenic strains)
Immune mediated (time for A% formation)
Granular deposits of IgG'Ig! ; 2* in G1!'
(su%epithelial location common)
/umps in G1! on 3! or IF !icroscopy/umps in G1! on 3! or IF
!icroscopy
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Pathogenesis of 4iffuse PGN:
Streptococcal infection 0 Immune comple"Streptococcal infection
0 Immune comple"deposition' inflammation ;
proliferation#deposition' inflammation ; proliferation#
Glomerular capillary o%struction:Glomerular capillary
o%struction:
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Progression of 4PGN:
Poststreptococcal4PGN
+)8+)8
Focal segmentalglomerulosclerosis
$u%ulo Interstitial4amage
+om'lete :ealing+om'lete :ealing
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2linical Features: G#Nephritis
=/ypertension
=S9in Infections
=2ongesti+e 2ardiac Failure
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5a%oratory Features: G#Nephritis
=Inflammation=4ecreased filtration
=4amage to filtration unit
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IF0 4iffuse Proliferati+e GN
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2omplications:
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Glomerular diseases:
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2hronic Glomerulonephritis:
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Urine !icroscopy :
2ells 2asts 2rystals2ells 2asts 2rystals#
2asts are formed 8ithin nephron#
2asts Suggest Kidney pathology#
2asts can %e made up of Protein' lipid' cells
or mi"ed#
2rystals suggest high concentration or altered
solu%ility#
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Formation of 2asts:
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.ed cell 2asts in Urine:
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The greatest test of courageThe greatest test of courage
is to bear defeatis to bear defeat
without losing heart…!without losing heart…!
.o%ert G# Ingersoll
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Glomerular diseases:
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!inimal 2hange5ipoid :
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!inimal 2hange 4isease:
Loss o< Foot 'rocesses
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!em%ranous GN :
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2rescentic GN 0 (.PGN)
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2rescentic GN 0 ($richrome Stain)
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Goodpasture Syndrome:
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Focal Segmental Gl# Sclerosis:
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!esangiocapillary GN: (!PGN)
