Nephritic Syndromes Dr. Raid Jastania

Nephritic Syndrome Diffuse Proliferative (post infectious) GN Rapidly Progressive GN (Crescentic GN) IgA Nephropathy Chronic Glomerulonephritis

Acute Proliferative/Diffuse Proliferative/Post-infectious Glomerulonephritis Post strep (staph, measles, mumps, HepB, HepC) Immune complex

Acute Proliferative/Diffuse Proliferative/Post-infectious Glomerulonephritis Light microscopy

Acute Proliferative/Diffuse Proliferative/Post-infectious Glomerulonephritis Light microscopy: Proliferative: mesangial, endothelial, inflammation (neutrophils) Thrombi necrosis

Acute Proliferative/Diffuse Proliferative/Post-infectious Glomerulonephritis Electron microscopy:

Acute Proliferative/Diffuse Proliferative/Post-infectious Glomerulonephritis Electron microscopy: Sub-epithelial humps Other deposits

Acute Proliferative/Diffuse Proliferative/Post-infectious Glomerulonephritis Immuno Fluorescence: Ig, Comp

Acute Proliferative/Diffuse Proliferative/Post-infectious Glomerulonephritis Prognosis

Acute Proliferative/Diffuse Proliferative/Post-infectious Glomerulonephritis Prognosis: Progression is uncommon 15-50% may progress to CRF

Rapidly Progressive GN (Crescentic GN)

Rapidly Progressive GN (Crescentic GN) Type I: Anti GBM 12% LM: Crescent IF: Linear deposits, IgG, C3 EM: deposits, GBM rupture

Rapidly Progressive GN (Crescentic GN) Type II: Immune complex 44% Post strep, IgA nephropathy LM: crescent IF: deposits similar to the primary disease EM: deposits, GBM rupture

Rapidly Progressive GN (Crescentic GN) Type III: Pauci-immune, ANCA positive 44% Vasculitis: Wegener granulomatosis, microscopic polyarteritis LM: crescent IF: neg EM: neg, GBM rupture

IgA Nephropathy

IgA nephropathy Children, young adults Microscopic, gross hematuria, recurrent Loin pain Association: Henoch-Schonlein purpura, Celiac disease, Liver disease

IgA nephropathy Pathogenesis

IgA nephropathy Pathogenesis: Abnormal IgA production and clearance High level of IgA Deposits of IgA Immune complex Activation of alternative complement system (C3 only)

IgA nephropathy Light micorscopy

IgA nephropathy Light microscopy: Normal or mesangial expansion

IgA nephropathy Immuno Fluorescence:

IgA nephropathy Immuno Fluorescence: IgA in mesangium

IgA nephropathy Electron microscopy

IgA nephropathy Electron microscopy: deposits

IgA nephropathy Prognosis:

IgA nephropathy Prognosis: 25-50% progress to CRF

Chronic Glomerulonephritis

Chronic Glomerulonphritis Late stage of glomerular disease Found in end-stage renal disease/CRF Represent 30-50% of patients on hemodialysis Young and middle age

What are the possible causes of this appearance of the kidneys?

Describe the four compartments (glomeruli, tubules, interstitium, and vasculature)

Describe the abnormality

Chronic Glomerulonphritis Gross: Contracted kidneys Atrophic with granular surface

Chronic Glomerulonphritis Micro: Glomerular sclerosis/hyalinizaiton Interstitial fibrosis/inflammation Tubular atrophy Thick vessels (hypertension)