1. Glomerulonephritis
Michael Pakdaman
MS - 3

2. Glomerulus – Anato / Histo

3. Nephr I / O tic ????

4. 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
Poststrep GN (Type III)
IgA Nephropathy (Type III)
Goospasture’s (Type II)
1 “membrane”
Membranoproliferative
2 others
Crescentic
Alport’s (collagen IV defect)

5. Hypersensitivity Essentials 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. Goodpasture’s (anti-GBM) Capillary BM of glomerulus & alveolar walls
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)