1. Nephritic Syndromes
Dr. Raid Jastania

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

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

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

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

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

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

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

9. Acute Proliferative/Diffuse Proliferative/Post-infectious Glomerulonephritis
Prognosis

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

11. Rapidly Progressive GN (Crescentic GN)

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

14. 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

15. 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

16. IgA Nephropathy

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

18. IgA nephropathy
Pathogenesis

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

20. IgA nephropathy
Light micorscopy

21. IgA nephropathy
Light microscopy:
Normal or mesangial expansion

22. IgA nephropathy
Immuno Fluorescence:

23. IgA nephropathy
Immuno Fluorescence:
IgA in mesangium

24. IgA nephropathy
Electron microscopy

25. IgA nephropathy
Electron microscopy:
deposits

26. IgA nephropathy
Prognosis:

27. IgA nephropathy
Prognosis:
25-50% progress to CRF

28. Chronic Glomerulonephritis

29. 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

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

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

32. Describe the abnormality

33. Chronic Glomerulonphritis
Gross:
Contracted kidneys
Atrophic with granular surface

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