You can see the tram tracking or splitting of the basement membranes here

Appel, Columbia

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WHO Classification I:normal glomeruli II:pure mesangial alterations III:focal segmental glomerulonephritis IV:diffuse proliferative glomerulonephritis V:membranous glomerulonephritis VI: sclerosing glomerulonephritis

Diabetic nephropathy Diabetic nephropathy has become the single most common cause of ESRD in the Western world Patients with type 2 DM do poorly on dialysis and have an excess mortality An interdisciplinary approach is needed for these patients, and nephrologists must deal with a spectrum of co-morbidities (CVD, stroke, peripheral vascular disease, retinopathy) besides nephropathy

How do microvascular complications, including renal disease, develop? High glucose induces generation of reactive oxygen species Proteins modified by glucose, i.e. Amadori products, and advanced glycation products (AGEs) play a pivotal role TGF-  is crucial in the development of renal hypertrophy and ECM accumulation Later, irreversible changes such as interstitial fibrosis and glomerulosclerosis develop Concomitant with renal hypertrophy, hyperfiltration and intra-renal hypertension develop

RPGN Superimposed on primary renal disease: IgA, membranous, MPGN, hereditary nephritis Associated with infectious, systemic diseases Has non-specific symptoms, insidious onset Diagnosis according to primary disorder: ANCA, post-infectious, Goodpasture syndrome Usually requires aggressive therapy