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glomerular disease
1.
2.
3. The main purpose of the kidney is to
separate urea, mineral salts, toxins, and
other waste products from the blood.
They also do the job of conserving water,
salts, and electrolytes.
At least one kidney must function properly
for life to be maintained.
19. DEFINITION
Abnormalites of glomerular funtion can be
caused by damage to the major components of the
glomerulus: Epithelium (podocytes), Basement
membrane, capillary endothelium, mesangium.
Damage manifested by an inflammatory process.
20.
21. Histologic alterations
a) hypercellularity:
i) cell proliferation of mesangial cells or
endothelial cells
ii) leukocyte infiltration (neutrophils,
monocytes and sometimes lymphocytes)
iii) formation of crescents
- epithelial cell proliferation (from
immune/inflammatory injury)
- fibrin thought to elicit this injury
(TNF, IL-1, IFN- are others)
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22. b) basement membrane thickening
- thickening of capillary wall
c) hyalinization (hyalinosis) and sclerosis
-accumulation of material that is
eosinophilic and homogeneous
- obliterates capillary lumen of glomerulus
(sclerotic feature)
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23. classification is based on histology.
Subdivided:
a) diffuse (all glomeruli)
b) global (entire glomerulus)
c) focal (portion of glomeruli)
d) segmental (part of each glomerulus)
e) mesangial (affecting mesangial region)
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24. What causes
glomerular disease ?
Most are of
immunologic origin, and
caused by immune
complexes !
• metabolic stress: DN
• mechanical stress:
• hypertension
27. Pathogenesis of Glomerular Disease
Immune mechanisms underlie most cases of
primary GN and many of the secondary cases
a) 2 forms of Ab-associated injury
i) injury resulting from soluble Ag-Ab
deposits in glomerulus
ii) injury from Ab reacting in-situ with
glomerulus
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28. • In Situ Immune Complex Deposition
a) Ab act directly with intrinsic tissue Ag
“planted” in the glomerulus from the
circulation
b) 2 forms of Ab-mediated glomerular
injury
i) anti-GBM Ab-induced nephritis
- Ab directed against fixed Ag in
ii) Heymann nephritis
- a form of membranous GN
- Ab bind along GBM in “granular
pattern”
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35. Various types of glomerulopathies are
characterized by one or more of four basic
tissue reactions:
1. Hypercellularity
2. Basement membrane thickening
3. Hyalinosis
4. Sclerosis
36.
37. Common form of GN in developing countries.
6 to 10yrs of age
1 - 4 weeks after a streptococcal infection of pharynx
or skin (Impetigo)
Group A β-haemolytic streptococci - types 12, 4, 1
Immunologically mediated disease
Immune Complex mediated
Anti - endostreptosin & other cationic antigens .
Serum – C
38. Glomeruli-
Enlarged , hypercellular glomeruli
- infiltration by leukocytes
- proliferation of endothelial &
mesangial cells,
- crescent formation (severe cases)
- obliteration of capillary lumen
Fibrin deposition in capillary lumen &
mesangium.
Interstitial edema and leucocytic infiltration
Tubules contain red cell cast.
Diffuse
49. Severe glomerular injury
Does not denote a specific etiologic form
of GN
Clinically - rapid & progressive loss of
renal function & death within weeks to
months
Crescents in most glomeruli – parietal
epithelial cells proliferation;
50. Type - I RPGN ( Anti-GBM antibody
induced disease)
.. Idiopathic,
.. Goodpasture syndrome;
Type - II RPGN (immune Complex)
.. Idiopathic, postinfecious, SLE,
Henoch-Schonlein purpura (IgA), others;
Type - III RPGN ( Pauci-immune )
.. ANCA associated, Idiopathic,
Wagener granulomatosis, PAN;
51. Linear deposits of IgG , C3 in GBM
Cross reaction with pulmonary
alveolar BM
Good - Pasture’s antigen located in
noncollagenous portion of α3
domain of collagen type - IV
52. Immune complex mediated disease
Complication of immune complex nephritides
- Post infectious GN , SLE , IgA nephropathy
Granular deposit of immune complexess of
IgG and C3 along glomerular capillary walls.
IF - lumpy bumpy granular pattern
53. Lack of anti GBM antibody , immune
complexes by IF , EM
ANCA present- defect in humoral immunity.
Usually a component of systemic vasculitis -
Wegeners Granulomatosis , Polyarteritis
Idiopathic
54. Gross :
Kidneys enlarged , pale ,smooth
outer surface.
C/S petechial hemorrhages on
cortical surface
55. Crescents
proliferation of parietal cells migration of
monocytes ,macrophages into Bowmans space
Crescents obliterate Bowman’s space ,
compress glomerular tuft
Fibrin strands are prominent between cellular
layers in the cresents.
56.
57.
58. Crescents Sclerosis
EM : subepithelial deposits
ruptures in GBM
IF : Postinfectious cases - granular
Good Pastures syndrome - linear
Idiopathic - granular / linear
64. Latent GN
(asymptomatic
urinary
abnormalities)
Nephrotic
syndrome
Acute GN RPGN Chronic GN
microscopic or
Macroscopic
hematuria
Proteinuria
Dysmorphic
Glomerular
erythrocytes
Proteinuria>3.5g/d
Hypoalbuminemia
Hyperlipidemia
Edema
Hematuria
Proteinuria
(1-3g/d)
ARF
Edema
Hypertension
Red cell casts
•Rapidly
deterioration of
renal function
•Hematuria,
Proteinuria
• oliguria or
anuria
Red cell casts
•With or
without
systemic
symptom
•Hematuria
Proteinuria
•Hypertens
on
•Reduced
GFR