Glomerular Diseases Not arising from the organism but

Majority are of immune origin, resulting from from an immunological post-

immunologic disorders streptococcal reaction
Forms immune complexes (as a result of
immunologic reactions and increase in serum Streptococci form immune complexes with antibodies
immunoglobions)
These immune complexes are deposited on Complexes deposited in glomerular membrane
the glomerular membranes and attracts
complement, neutrophils, lymphocyte, Inflammatory reaction affects glomerular function
monocytes and cytokines
Results to CHANGES or DAMAGES in the Occurs approximately 7 to 12 days
glomeruli postinfection
o Damages Sudden onset of symptoms consistent with
1. Cellular Infiltration or glomerular membrane damage
proliferation resulting in No permanent kidney damage
thickening of the glomerular Immune complexes may be cleared
basement membrane from blood
2. Complement-mediated No inflammation
damage to the capillaries Successful management of secondary
and basement membrane complications, hypertension and
Non-immunologic causes: electrolyte imbalance
1. Exposure to chemicals or toxins Occasionally seen with other bacterial and
2. Disruption of the electrical membrane viral agents
charges (nephrotic syndrome) Pneumonia, endocarditis and severe
3. Deposition of amyloid material from systemic infections
disorders (chronic inflammation and acute-
phase reactants)
4. Basement membrane thickening (diabetic Acute Poststreptococcal Glomerulonephritis
nephropathy) Symptoms Urinalysis Other Findings
Present with nephritic syndrome and nephrotic Edema (often Hematuria Elevated BUN
syndrome around the (lasts until Elevated serum
Proteinuria increase of amount of protein in eyes) damage is antistreptolysin
urine Hypertension repaired) O (ASO) titer
o Commonly seen in tubular injury and Oliguria Proteinuria and Anti-group A
glomerular kidney injuries Hematuria oliguria streptococcal
o Adults normal = 150 mg/dL (0.15 RBC casts
Fatigue enzyme tests
g/dL) of protein Dysmorphic
o Disease = >2 g/dL because of RBCs
affected glomerular filtration
Hyaline and
o Nephrotic Syndrome Proteinuria =
Granular Casts
>3.5 g/dL
WBCs
Glomerulonephritis
B. Rapid Progressive (Crescentic) Glomerulonephritis
A sterile, inflammatory process that affects the
a.k.a. Necrotizing or Crescentic
glomerulus
Glomerulophritis
Results in protein, blood and casts in urine
Due to its pathological appearance
One type may change into another type over time
with crescent-shaped glomeruli
Rapidly progressive glomerular nephritis
A form of acute kidney disease that causes
(RPGN) Chronic glomerulonephritis
damage to the glomeruli and progressive loss
Nephrotic syndrome Renal failure of kidney function over weeks to months
Common in adults aged 40 60 years old
Types:
Deposition of immune complexes in
A. Acute Poststreptococcal Glomerulonephritis
glomerulus
A diffuse proliferative glomerulonephritis
Complication of (1) another form of
An autoimmune condition that may arise
glomerulonephritis or (2) or an
after a group A streptococcus (Streptococcus
immune systemic disorder like
pyogenes) infection of the throat or skin
Systemic Lupus Erythematosus (SLE)
Contains M protein in cell wall
 Macrophages damages the walls of capillaries
Wegeners Granulomatosis
Cells and plasma released into Bowmans space Causes a granuloma-producing inflammation of the
small blood vessels of primarily the kidney and
Production of crescentic formations (with macrophages, respiratory system
fibroblasts and polymerized fibrin) Demonstration of antineutrophilic cytoplasmic
antibody (ANCA)
Permanent damage to capillary tufts o Binding of ANCA to neutrophils on the
vascular walls may initiate immune response
May show up as nephritic syndrome or as resulting to granuloma formation
unknown kidney failure
Causes or risk factors: Wegeners Granulomatosis
1. Vascular, blood or lymphatic Symptoms Urinalysis Other Findings
disorders Pulmonary Hematuria Elevated BUN
2. Membranoproliferative symptoms Proteinuria Elevated
glomerulonephritis Renal RBC casts creatinine
3. History of cancer involvement Antineutrophilic
4. Exposure to hydrocarbon solvents cytoplasmic
antibody in serum
Rapid Progressive (Crescentic) Glomerulonephritis
Symptoms Urinalysis Other Findings Henoch-Schonlein Pupura
Edema Hematuria Elevated BUN A decrease in platelets disrupting vascular integrity
Hypertension (lasts until Very low Appearance of raised, red patched in the skin
Blood in the damage is glomerular o Purpura are small capillary hemorrhages
urine (dark or repaired) filtration rates Disease occurring primarily in children
smoke-colored) Proteinuria Demonstration 50% of patients recover normal renal function
Decreased and oliguria of increased May lead to renal complications
urine volume RBC casts fibrin o Glomerulonephritis and renal failure
Deposition of degradation
IgA complexes products and Wegeners Granulomatosis
in glomerulus cryoglobulins Symptoms Urinalysis Other Findings
General malaise Raised, red Hematuria Elevated
patches in the skin Proteinuria BUN
Goodpasture Syndrome Respiratory RBC casts Elevated
An autoimmune disease with cytotoxic autoantibodies symptoms creatinine
to collagen (glomerular and alveolar basement Gastrointestinal Stool occult
membranes) that are called antiglomerular basement symptoms blood
membrane antibodies Blood in sputum
With subsequent complement activation and in stool
producing glomerular capillary destruction
Autoantibody can be detected in patient Membranous Glomerulonephritis
serum Caused by pronounced thickening of glomerular
Can follow viral infections basement membrane
Affects both kidneys and lungs Resulting from deposition of IgG immune
o Involves rapidly progressive kidney failure complexes
(resembles RPGN) One of the most common causes of nephrotic
o Develops into a lung disease in days to weeks syndrome
Progression to chronic glomerulonephritis and end- May also lead to thrombosis (formation of blood clot)
stage renal failure common May be a primary kidney disease of uncertain origin or
may be associated with:
Goodpasture Syndrome SLE
Symptoms Urinalysis Other Findings Sjogren Syndrome (defect in glandular
Hemoptysis Hematuria Antiglomerular production of moisture)
Dyspnea Proteinuria basement Secondary syphilis
Hematuria RBC casts membrane Hepatitis B
Hypertension antibody in
Gold and mercury treatments
Proteinuria serum
Malignancy
 o Multiple myeloma
o Immune disorders (AIDS)
Membranous Glomerulonephritis Chronic Glomerulonephritis
Symptoms Urinalysis Other Findings Symptoms Urinalysis Other Findings
Foamy urine Microscopic Antinuclear Azotemia Hematuria Elevated BUN
Edema hematuria antibody Foamy Urine Proteinuria Elevated
Weight gain Proteinuria Hepatitis B Decreased Glucosuria creatinine
Hypertension surface antigen alertness Cellular and Decreased
Nocturia Fluorescent Drowsiness granular casts glomerular
Tendency of treponemal Somnolence Waxy and filtration rate
thrombosis antibody- Lethargy broad casts (Creatinine
absorption test Delirium clearance)
(FTA-ABS) Confusion Electrolyte
Coma imbalance
Membranoproliferative Glomerulonephritis Seizures
a.k.a. Mesangiocapillary glomerulonephritis Decreased
Marked by two different alterations in the cellularity of sensations in
the glomerulus and peripheral capillaries hand, feet and
Usually affects children other areas
Associated with: Easy bruising or
Autoimmune disorders bleeding
Infections Frequent hiccups
Malignancies Malaise
Generalized
Types: itching
A. Membranoproliferative Glomerulonephritis Type I Headache
Increased cellularity in the subendothelial Increased skin
cells of the mesangium (interstitial area of pigmentation
Bowmans capsule), causing thickening of (yellow or
capillary walls brown)
Deposits of antibody builds up Muscle cramps
Progresses to nephrotic syndrome Muscle twitching
Nusea
B. Membranoproliferative Glomerulonephritis Type II Vomitting
Displays extremely dense deposits in the Need to urinate
glomerular basement membrane at night
Unintentional
Membranoproliferative Glomerulonephritis weight loss
Symptoms Urinalysis Other Findings
Edema Hematuria Decreased Immunoglobulin A Nephropathy
Hypertension Oliguria serum a.k.a. Berger Disease
Azotemia Proteinuria complement Immune complexes containing IgA are deposited on
Change in levels the glomerular membrane
mental status Most frequently seen in children and young adults
Most common cause of chronic glomerulonephritis
Chronic Glomerulonephritis Increased serum levels of IgA
Advanced stage of several kidney disorders, resulting May be caused by mucosal infection
in inflammation and slowly worsening destruction of Recovery from macroscopic hematuria is spontaneous
glomeruli, with progressive loss of kidney function o Microhematuria and elevated IgA in serum
Causes: remain
Diabetic nephropathy/sclerosis Patient may be asymptomatic for 20 years or more
Focal segmental glomerulosclerosis
IgA nephropathy Immunoglobulin A Nephropathy
Lupus nephritis Symptoms Urinalysis Other Findings
Membranous glomerulonephritis Asymptomatic Macroscopic or Increased
Mesangial proliferative disorder microscopic serum IgA
Nephritis, associated with: hematuria level
o Amyloidosis