Glomerulonephritis
Definition
Inflammation of glomerulus
IgA nephropathy (most common - adult)
Poststreptococcal GN/ Acute proliferative (Nephritic)
Postinfectious GN/ Non streptococcal acute GN (Nephritic)
Cresenteric GN (ARF + Nephritic)
Minimal change disease (Nephrotic)
Membranous GN (Nephrotic)
Focal and segmental glomerulosclerosis (Nephrotic)
Membranoproliferative GN (Nephrotic/ nephritic)
Source
Robbins Pathology 8th Ed
Harrisons 16th Ed
Inflammation of glomerulus
IgA nephropathy (most common - adult)
- Following URTI (rarely GIT/ UTI)
- Aetiopathogenesis: Inc systemic IgA --> deposition in glomerulus --> trigger mesangial/ endothelial proliferation --> segemental glomerulosclerosis
- CFx: Painless haematuria and/or proteinuria, with pharyngitis
- Ix: Normal C3/4
- Rx: Manage HTN
- Prognosis: Excellent
Poststreptococcal GN/ Acute proliferative (Nephritic)
- Usually children
- Aetiology: after GAS infection (~7-12d (throat), 3/52 (skin))
- Pathogenesis: Immune complex deposit in mesangium
- CFx: Nephritic synd, after inf (cf IgA: with)
- Ix: dec C3/4
- Rx: Abx if persistent inf, manage HTN
Postinfectious GN/ Non streptococcal acute GN (Nephritic)
- Similar to above except aetiology
- Aetiology: Bact (Staph, Pneumococcal, Meningococcal), Viral (HBV, HCV, mumps, HIV), parasites (malaria, toxoplasmosis)
Cresenteric GN (ARF + Nephritic)
- Severe
- Aetiology:
- Type I: Goodpasture's syndrome (anti-glomerular basement membrane aGBM ab). Affects lungs too.
- Type II: Immune complex. More severe form. Includes Henoch-Schonlein, SLE (ANA), IgA
- Type III: GPA (Wegener's). ANCA ab.
- Type IV: Combination of I and III
- CFx: Nephritic, ARF
- Rx: I = immunosuppresion/ plasmaphoresis, II = rx cause + immunosuppresion, III = steroids/ cytotoxic agents
Minimal change disease (Nephrotic)
- Most common GN in 2-6y
- After URTI (or immunisation)
- Aetiopathogenesis: inc cytokines in rxn to URTI --> destruction of podocytes
- CFx: Nephrotic (albumin selective)
- Ix: Normal C3/4
- Rx: Steriods
- Prognosis: Excellent
Membranous GN (Nephrotic)
- Common in 30-50y
- Aetiopathogenesis: Drugs (NSAIDs/ gold), malignancy, HBV, HCV, SLE --> Immune complex deposition --> ab attack endothelium + mesangium
- CFx: nephrotic, +/- microscopic haematuria
- Rx: NOT responsive to steroids. Rx cause
- Prognosis: 50% ESRF in 10y
Focal and segmental glomerulosclerosis (Nephrotic)
- Affects some glomerulus (focal) and some parts of glomerulus (segmental)
- Common in adults
- Aetiopathogenesis: HIV/ heroin/ obesity/ sickle cell --> renal injury --> glomerular hypertrophy --> change in blood flow --> endothelial injury --> inc protein in mesangium --> mesangium proliferation --> inc mesangial ECM --> segmental sclerosis --> global sclerosis
- CFx: Nephrotic
- Rx: Manage HTN
Membranoproliferative GN (Nephrotic/ nephritic)
- Aetiopathogenesis: Immune complex --> endothelia;/ mesangial proliferation
- CFx: Nephrotic and nephritic
- Rx: Manage HTN
Source
Robbins Pathology 8th Ed
Harrisons 16th Ed