Glomerular Disorders

acute glomerulonephritis

deposition of immune complexes on glomerular membranes—formed in conjunction with B-hemolytic Group A Streptococcus

acute glomerulonephritis

• rapid onset of hematuria & edema

• permanent renal damage seldom occurs

acute glomerulonephritis

• macroscopic hematuria

• proteinuria

• RBC cast

• granular casts

Anti-group A streptococcal enzyme tests

significant test for

rapidly progressive glomerulonephritis

deposition of immune complexes on glomerular membrane—from systemic immune disorders

rapidly progressive glomerulonephritis

• rapid onset w/ glomerular damage

• possible progression to end-stage renal failure

rapidly progressive glomerulonephritis

Goodpasture’s syndrome

Wegener’s granulomatosis / Granulomatosis w/ polyangitis

Henoch-Schonlein purpura

• macroscopic hematuria

• proteinuria

• RBC casts

• BUN

• Creatininw

• eGFR

significant test for rapidly progressive glomerulonephritis

Goodpasture’s syndrome

attachment of cytotoxic antibody to glomerular & alveolar basement membrane—formed during viral respiratory infections

Goodpasture’s syndrome

• hemoptysis (blood in sputum)

• dyspnea

• hematuria

anti-glomerular basement membrane antibody

significant test for Goodpasture’s syndrome

Wegener’s granulamotosis / Granulomatosia w/ polyangitis

antineutrophilic cytoplasmic autoantibody (ANCA) binds to neutrophils in vascular walls → damage to small vessels in lungs & glomerulus

Wegener’s granulamotosis / Granulomatosia w/ polyangitis

• pulmonary symptoms—hemoptysis

• renal involvement

• possible regression to end-stage renal failure

antineutrophilic peripheral or cytoplasmic antibody

significant test for Wegener’s granulamotosis / Granulomatosia w/ polyangitis

• ethanol: perinuclear ANCA

• formalin: cytoplasmic ANCA

antineutrophilic cytoplasmic antibody when neutrophils are stained with:

• ethanol

• formalin

Henoch-Schonlein Purpura

occurs primarily in children after viral respiratory infections → decrease in platelets → disrupts vascular integrity

Henoch-Schoenlein purpura

• purpura

• blood in sputum & stools

• renal involvement

• complete recovery is common, but may progress to renal failure

stool occult blood—Guiac test

significant test for Henoch-Schoenlein purpura

IgA nephropathy / Berger disease

increased serum IgA → deposition of IgA on the glomerular membrane

IgA nephropathy / Berger disease

• recurrent microscopic hematuria after exercise

• slow progression to chronic glomerulonephritis

IgA nephropathy / Berger disease

macroscopic & microscopic hematuria

serum IgA

significant test for IgA nephropathy / Berger disease

membranous glomerulonephritis

IgG immune complex deposition from systemic disorders → thickening of the glomerular membrane

membranous glomerulonephritis

slow progression to nephrotic syndrome or possible remission

membranous glomerulonephritis

microscopic hematuria & proteinuria

• antinuclear antibody

• HBsAg

• fluorescent treponemal antibody-absorption test

significant test for membranous glomerulonephritis

membranous proliferative glomerulonephritis

cellular proliferation affecting capillary walls or glomerular basement membrane, possibly immune mediated

membranous proliferative glomerulonephritis

slow progression → chronic glomerulonephritis or nephrotic syndrome

membranous proliferative glomerulonephritis

hematuria

serum complement levels

significant test for membranous proliferative glomerulonephritis

chronic glomerulonephritis

marked decrease in renal function—from glomerular damage precipitated by other renal disorder

chronic glomerulonephritis

noticeable decrease in renal function → renal failure

chronic glomerulonephritis

• hematuria

• proteinuria

• glucosuria

• cellular, granular, waxy, broad casts

nephrotic syndrome

glomerular disorder w/ the heaviest proteinuria of > 3.5g / day

• BUN

• serum creatinine

• eGFR

• electrolytes

significant test for chronic glomerulonephritis

nephrotic syndrome

disruption of shield of negativity & damage to tightly fitting podocyte barrier → massive loss of proteins & lipids

nephrotic syndrome

• acute onset after systemic shock

• gradual progression from other glomerular disorders

nephrotic syndrome

• hematology

minimal change disease

nephrotic syndrome in children

minimal change disease

allergic reactions & immunizations; dysfunction of T-cell immunity → disruption of podocytes primarily in children

focal segmental glomerulosclerosis

disruption of posodocytes in certain areas of glomeruli—heroin & analgesic abuse, HIV & hepatitis virus

acute