Glomerulonephritis Michael Pakdaman MS - 3

Glomerulus – Anato / Histo

Nephr I / O tic ????

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)

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

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)

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

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

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

Membranoproliferative “tram-tracking”

Goodpasture’s (anti-GBM) Capillary BM of glomerulus & alveolar walls Linear – Type II Goodpasture’s (anti-GBM) Capillary BM of glomerulus & alveolar walls

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)