Pathology & Pathophysiology of Glomerulonephritis Kidneys Normal Glomerulus Functions Remove wastes from body Regulate electrolytes Regulate blood pressure Stimulate RBC production GBM Ultrafiltration barrier, 310-380nm Mesangial cells Regulate Blood flow in glomerulus Phagocytic activity Epithelial cell (Epc) Glomerular permeability Clinical manifestation (Glomerular disease) Nephritic syndrome (not a disease) Nephrotic syndrome (not a disease) Rapidly progressive renal failure Chronic renal failure Syndromes Nephritic Nephrotic Hematuria Massive Proteinuria > 3.5G /day Azotemia ( ↑BUN) Hypoalbuminaemia (plasma albumin <3g/dL) Proteinuria Oliguria Generalised Edema Edema Hyperlipidaemia Hypertension Clinical outcome (Glomerular disease) Proteinuria Disturbance of Sieving (filter) function Ultrafiltrate contains large molecules Oliguria ↓ GFR Edema, Hypertension Disturbance in Electrolyte regulation Hematuria Inability to keep RBC in capillary lumen Chronic Renal Failure Chronic ↓ in GFR Terminology of Glomerular Lesions Histological Diagnosis Acute glomerulonephritis Chronic glomerulonephritis Acute diffuse proliferative GN Rapidly progressive GN (Crescentic GN) Mesangial proliferative GN Focal Segmental GN Minimal change GN Membranous GN Mechanisms of Glomerular Injury Depositions of Preformed Immune Complex Formations of Immune Complex In Situ Compliment activation Nephrotoxic Antibody to GBM (Glomerular Basement Membrane) Antigens Endogenous Exogenous SLE Nephritis Poststreptococcal nephritis Hepatitis B (HbsAg) Infection Treponema pallidum Plasmodium falciparum Variations Same cause may give spectrum of change in glomeruli Same cause may give different effect on different people Same cause may give no effect on some people Different organisms may give same changes in glomeruli Antigen cause Renal Damage Antigen- Antibody complexes are formed in circulation Trapped in glomeruli Binds complements (most cases) Get deposited – Mesangium, Subendothelial, Subepithelial Stimulate Acute Inflammatory reaction Lead to Glomerular Cell Proliferation Causes of Antigen-Antibody trapped in Glomeruli Charge of immune complex Haemodynamic factors (glomerulus) Permeability of endothelial cells Immune Mediated Injury Non- Inflammatory Inflammatory
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