Post on 02-Feb-2016
description
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)