Dr. Roopam Jain, Professor & Head, Dept. Of Pathology & BLOOD BANK

1. The KIDNEY - 4
DR. ROOPAM JAIN
PROFESSOR & HEAD, PATHOLOGY

2. GLOMERULAR DISEASES
DEFINITION AND CLASSIFICATION
• Glomerulonephritis (GN) or Bright’s disease is the term used for diseases
that primarily involve the renal glomeruli.
• classify - 2 broad groups:
• I. Primary glomerulonephritis in which the glomeruli are the
predominant site of involvement.
• II. Secondary glomerular diseases include certain systemic and
hereditary diseases which secondarily affect the glomeruli

3. Clinicopathologic classification of
glomerular diseases

4. Clinicopathologic classification of
glomerular diseases

5. GLOMERULAR DISEASES
CLINICAL MANIFESTATIONS
• The clinical presentation of glomerular disease is quite variable but in
general four features—
• proteinuria,
• haematuria,
• hypertension and
• disturbed excretory function

6. GLOMERULAR DISEASES
• Following six major glomerular syndromes are commonly found in
different glomerular diseases:
• Nephritic and nephrotic syndromes;
• Acute and chronic renal failure;
• Asymptomatic proteinuria and haematuria

7. I. ACUTE NEPHRITIC SYNDROME
• This is the acute onset of microscopic haematuria, mild proteinuria,
hypertension, oedema and oliguria following an infective illness about 10
to 20 days earlier.
• 1. Haematuria
• 2. Proteinuria
• 3. Hypertension
• 4. Oedema
• 5. Oliguria

8. I. ACUTE NEPHRITIC SYNDROME

9. II. NEPHROTIC SYNDROME
• Nephrotic syndrome is characterised by
• massive proteinuria,
• hypo-albuminaemia,
• oedema,
• hyperlipidaemia,
• lipiduria
• hypercoagulability.

10. CAUSES OF NEPHROTIC SYNDROME

11. CAUSES OF NEPHROTIC SYNDROME

12. Contrasting features of acute nephritic &
nephrotic syndrome

13. Contrasting features of acute nephritic &
nephrotic syndrome

14. III. ACUTE RENAL FAILURE
• As already described above, acute renal failure (ARF) is characterised
by rapid decline in renal function.
• ARF has many causes including glomerular disease, principally rapidly
progressive GN and acute diff use proliferative GN

15. IV. CHRONIC RENAL FAILURE
• Glomerular causes of chronic renal failure (CRF) have already been
described.
• These cases have advanced renal impairment progressing over years
and is detected by significant proteinuria, haematuria, hypertension and
azotaemia.
• Such patients generally have small contracted kidneys due to chronic
glomerulo nephritis

16. V. ASYMPTOMATIC PROTEINURIA
• Presence of proteinuria unexpectedly in a patient may be unrelated to
renal disease (e.g. exercise-induced, extreme lordosis and orthostatic
proteinuria), or may indicate an under lying mild glomerulonephritis.
• Association of asymptomatic haematuria, hypertension or impaired
renal function with asymptomatic proteinuria should raise strong
suspicion of underlying glomerulonephritis.

17. VI. ASYMPTOMATIC HAEMATURIA
• common in children and young adolescents
• causes such as diseases of the glomerulus, renal interstitium, calyceal
system, ureter, bladder, prostate, urethra, and under lying bleeding
disorder, congenital abnormalities of the kidneys or neoplasia.
• Glomerular haematuria is indicated by the presence of red blood cells,
red cell casts and haemoglobin in the urine.
• Glomerular haematuria is frequently associated with asymptomatic
proteinuria.

18. PATHOGENESIS
OF
GLOMERULAR
INJURY

19. • The consequences of injury at different sites within the glomerulus in
various glomerular diseases can be assessed when compared with the
normal physiologic role of the main cells involved i.e.
• endothelial,
• mesangial,
• visceral epithelial, and
• parietal epithelial cells as well as of the
• GBM

20. Relationship of physiologic role of
glomerular components with
consequences in glomerular injury.

21. Pathogenetic mechanisms in
glomerular diseases
• Immunologic mechanisms - primarily antibody-mediated (immune-
complex disease).
• cell-mediated immune reactions in the form of delayed type hyper
sensitivity can also cause glomerular injury in some conditions.
• In addition, a few secondary mechanisms and some non-immuno logic
mechanisms are involved in the pathogenesis of some forms of
glomerular diseases in human beings

22. Pathogenetic mechanisms in
glomerular diseases

23. Pathogenetic mechanisms in
glomerular diseases

24. Diagrammatic representation of ultrastructure of a portion
of glomerular lobule. It shows three patterns of irregular or
granular glomerular deposits in immune-complex disease.