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Glomerulonephritis Michael Pakdaman MS - 3. Glomerulus – Anato / Histo.

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Presentation on theme: "Glomerulonephritis Michael Pakdaman MS - 3. Glomerulus – Anato / Histo."— Presentation transcript:

1 Glomerulonephritis Michael Pakdaman MS - 3

2 Glomerulus – Anato / Histo

3 Nephr I / O tic ????

4 NephrOtic (PrOtein) NephrOtic (PrOtein) 3 Systemic Diseases 3 Systemic Diseases –Diabetes –SLE –Amyloidosis 1 membrane 1 membrane –Membranous GN 2 others 2 others –Minimal Change –Focal Segmental NephrItic (RBC +/- casts) NephrItic (RBC +/- casts) 3 Autoimmune 3 Autoimmune –Poststrep GN (Type III) –IgA Nephropathy (Type III) –Goospastures (Type II) 1 membrane 1 membrane –Membranoproliferative 2 others 2 others –Crescentic –Alports (collagen IV defect)

5 Hypersensitivity Essentials of GN Type I – IgE cross-linking on presensitizes mast cells inflammatory mediators released 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 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 III – Immune complex deposits (eg SLE) activates complement C5a chemotactic to neutrophils damage Type IV – T-cell mediated Type IV – T-cell mediated

6 NephrOtic Membranous (#1)– Type III HS Membranous (#1)– Type III HS –Immune deposits IN the GBM –Assoc w/ hepatitis B antigenemia, autoimmune diseases, thyroiditis, malignancies, pharm (gold, penicillamine, captopril, NSAIDs). penicillamine captoprilpenicillamine captopril Minimal Change Disease (#1 Kids) Minimal Change Disease (#1 Kids) –lipoid nephrosis (why???) –Tx w/ steroids Focal Segmental Glomerulosclerosis Focal Segmental Glomerulosclerosis –Presents w/ acute onset; Glomerular scarring –Mutliple etiology: Podocyte injury, Nephron loss, Renal vasodilatation (diabetic nephropathy, sickle cell, obesity, Von Gierkes, Pregnancy, Obesity, Healing of prior inflammatory injury)

7 NephrOtic – Systemic Disease Diabetes – (1) GBM thickening, (2) KW Nodules, (3) DIFFUSE glomerular sclerosis Diabetes – (1) GBM thickening, (2) KW Nodules, (3) DIFFUSE glomerular sclerosis SLE (Type III) – SubENDOthelial deposits SLE (Type III) – SubENDOthelial deposits Amyloidosis Amyloidosis apple green apple green

8 NephrItic – Autoimmune Poststrep GN (#1 acute) – type III (small – subepithelial humps) – follows sore throat or cellulitis Poststrep GN (#1 acute) – type III (small – subepithelial humps) – follows sore throat or cellulitis –Peripheral & periorbital edema (autoimmune) IgA – post-infectious – type III IgA – post-infectious – type III –Mild, self-limiting, assoc w/ Henoch-Sch Goodpastures – type II Goodpastures – type II –Men in mid 20s

9 NephrItic – Other 3 Membranoproliferative – MESANGIAL CELLS proliferate. Assoc w/ Hep C, SLE, a1-antitrypsin. Membranoproliferative – MESANGIAL CELLS proliferate. Assoc w/ Hep C, SLE, a1-antitrypsin. Crescentic GN – Fibrin deposition in Bowmans. Assoc w/ post-strep & membranous GN. Crescentic GN – Fibrin deposition in Bowmans. Assoc w/ post-strep & membranous GN. Alports – Hereditary, type IV collagen defect, CN VIII defective Alports – Hereditary, type IV collagen defect, CN VIII defective

10 Membranoproliferative tram-tracking

11 Linear – Type II Goodpastures (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)


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