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    Today Is The First Day, of Rest of Your Life... !

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    This document discusses glomerulonephritis (GN), which refers to diseases affecting the glomeruli of the kidney. It begins by providing an overview of normal kidney anatomy and the glomerular filtration process. It then discusses the pathogenesis and classification of various types of GN, including primary and secondary forms. Specific immune-mediated forms of GN are examined in more detail, covering their pathogenesis, clinical presentations, laboratory features, and histological patterns of glomerular damage. Examples of different types of immune GN discussed include post-streptococcal GN, crescentic GN, membranous GN, and minimal change disease. Complications and chronic progression of GN are also addressed.

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    Today Is The First Day, of Rest of Your Life... !

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    madhu
    35 views41 pages
    This document discusses glomerulonephritis (GN), which refers to diseases affecting the glomeruli of the kidney. It begins by providing an overview of normal kidney anatomy and the glomerular filtration process. It then discusses the pathogenesis and classification of various types of GN, including primary and secondary forms. Specific immune-mediated forms of GN are examined in more detail, covering their pathogenesis, clinical presentations, laboratory features, and histological patterns of glomerular damage. Examples of different types of immune GN discussed include post-streptococcal GN, crescentic GN, membranous GN, and minimal change disease. Complications and chronic progression of GN are also addressed.

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    Glomerulonephritis (3)

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    This document discusses glomerulonephritis (GN), which refers to diseases affecting the glomeruli of the kidney. It begins by providing an overview of normal kidney anatomy and the glomerular filtration process. It then discusses the pathogenesis and classification of various types of GN, including primary and secondary forms. Specific immune-mediated forms of GN are examined in more detail, covering their pathogenesis, clinical presentations, laboratory features, and histological patterns of glomerular damage. Examples of different types of immune GN discussed include post-streptococcal GN, crescentic GN, membranous GN, and minimal change disease. Complications and chronic progression of GN are also addressed.

    Copyright:

    © All Rights Reserved
    Download as PPT, PDF, TXT or read online from Scribd
    Download as ppt, pdf, or txt
    35 views41 pages

    Today Is The First Day, of Rest of Your Life... !

    Uploaded by

    madhu
    This document discusses glomerulonephritis (GN), which refers to diseases affecting the glomeruli of the kidney. It begins by providing an overview of normal kidney anatomy and the glomerular filtration process. It then discusses the pathogenesis and classification of various types of GN, including primary and secondary forms. Specific immune-mediated forms of GN are examined in more detail, covering their pathogenesis, clinical presentations, laboratory features, and histological patterns of glomerular damage. Examples of different types of immune GN discussed include post-streptococcal GN, crescentic GN, membranous GN, and minimal change disease. Complications and chronic progression of GN are also addressed.

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    of 41

    Today is the First Day,

    of Rest of Your Life...!

    Pathology of
    Glomerulonephritis
    Dr. Venkatesh Murthy Shashidhar
    Senior Lecturer in Pathology

    Normal Kidney:

    Normal Glomerulus (PAS)

    Anatomy:

    Cap. loops

    J.G.App.
    DCT
    Afferent.A

    DCT

    Efferent.A

    Filtration Unit:

    1. Fenestrated Endothelium
    2. Lamina Rara Interna
    3. Lamina Rara Densa
    4. Lamina Rara Externa
    5. Podocytes + Slit membrane

    Capillary Lumen

    Glomerular Filtration:
    BLOOD

    Glomerular Capillary Lumen

    Proteins
    3.6nm/70,000M
    W

    L.R.I
    L.D.
    L.R.E

    GBM

    Foot Process

    Plasma Proteins

    Podocyte
    (Visceral epithelium)

    FILTRATE

    Bowmans Capsule Space

    Pathogenesis:
    Immune mechanisms Most common
    Autoimmune
    Planted Antigen
    Immune complex.

    Toxins
    Metabolic

    Glomerular diseases:
    Primary GN:
    Acute Diffuse Prol.
    Poststrept & other Inf.
    Crescentic (Rapidly
    Progressive)
    Membranous GN.
    Lipoid / Minimal Change .
    Focal segmental G.sclerosis.
    Membranoproliferative GN.
    IgA nephropathy.
    Chronic Idiopathic GN.

    Associated with Systemic


    Diseases:
    SLE, DiabetesMellitus.
    Goodpasture's Syndrome.
    Polyarteritis Nodosa.
    Wegener's Granulomatosis.
    Henoch-Schonlein Purpura.
    Bacterial Endocarditis.
    Amyloidosis
    Hereditary Disorders:
    Alport's Syndrome.
    Fabry's Disease

    Pathogenesis of Immune GN:


    1. Ab, Ag/Ab or Immune complex deposition.
    2. Immune reaction
    3. Inflammation Activation of complement
    4. destruction of glomerular structure
    5. Renal dysfunction, Proteinuria, Hematuria

    Immune Glomerulonephritis:

    Glomerular damage - patterns:

    Immune Glomerulonephritis:
    In-Situ immune complex formation:
    Tissue antigens - Goodpasture anti GBM Ag
    Planted antigens - infections, toxins, drugs.

    Circulating immune complex deposition.


    Endogenous - DNA as in SLE
    Exogenous - infections.

    Cell mediated Immune injury

    Immune Glomerulonephritis:
    C.Immune Complex

    ANTI-GBM

    HEYMANN

    Clinical Syndromes:
    Nephritic syndrome.
    Oliguria, Haematuria, Proteinuria, Oedema.

    Nephrotic syndrome.
    Gross proteinuria, hyperlipidemia,

    Acute renal failure (RPGN).


    Oliguria, loss of Kidney function - within weeks

    Chronic renal failure.


    Over months and years - Uremia

    Nephritic Syndromes :
    Diffuse Proliferative GN
    Post Streptococcal.

    Rapidly Progressive GN (or Crescentic)


    Post Streptococcal, Goodpastures,

    Focal Glomerulonephritis
    Primary: Bergers disease (IgA Nephritis)
    Secondary IgA nephritis, Henoch Schonlein
    purpura, SBE, Coeliac Disease etc.

    Post Streptococcal GN
    (Prol.GN):

    1-4 weeks following streptococcal infection


    (nephritogenic strains)
    Immune mediated (time for Ab formation)
    Granular deposits of IgG,IgM & C3 in GBM,
    (subepithelial location common)
    Humps in GBM on EM or IF Microscopy

    Pathogenesis of Diffuse PGN:


    Streptococcal infection - Immune complex
    deposition, inflammation & proliferation.
    Glomerular capillary obstruction:
    J.G.A stimulation Renin high blood pressure
    Reduced filtration raised blood urea
    Fluid retention Oedema

    Damage to GBM:
    Unselective proteinuria (form Pr. casts in tubule)
    Haematuria (form RBC casts in tubule)

    Progression of DPGN:
    Poststreptococcal
    DPGN

    Focal segmental
    glomerulo
    sclerosis

    Complete Healing

    CGN

    Tubulo
    Interstitial
    Damage

    Clinical Features: G.Nephritis

    Hypertension
    Skin Infections
    Congestive Cardiac Failure

    Laboratory Features: G.Nephritis

    Inflammation
    Decreased filtration
    Damage to filtration unit

    Diffuse Proliferative GN:


    Hyperplasia of epithelium
    & endothelium.
    Cell Swelling.
    Inflammatory cells.
    Obstruction to flow.
    Enlarged hypercellular
    glomeruli.

    Normal

    Proliferative
    Post strepto

    IF- Diffuse Proliferative GN

    Complications:

    Glomerular diseases:

    Chronic Glomerulonephritis:

    Urine Microscopy :
    Cells Casts Crystals.
    Crystals
    Casts are formed within nephron.
    Casts Suggest Kidney pathology.
    Casts can be made up of Protein, lipid, cells
    or mixed.
    Crystals suggest high concentration or altered
    solubility.

    Formation of Casts:

    Red cell Casts in Urine:

    The greatest test of courage


    is to bear defeat
    without losing heart!
    Robert G. Ingersoll

    Glomerular diseases:

    Minimal Change/Lipoid :

    Minimal Change Disease:

    Loss of Foot processes

    Membranous GN :

    Crescentic GN - (RPGN)

    Crescentic GN - (Trichrome Stain)

    Goodpasture Syndrome:

    Membranous GN :

    Focal Segmental Gl. Sclerosis:

    Mesangiocapillary GN: (MPGN)

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