Sandbox:Mehrian

Diabetes mellitus Main page
Patient Information Type 1 Type 2
Overview
Classification Diabetes mellitus type 1 Diabetes mellitus type 2 Gestational diabetes
Differential Diagnosis
Complications
Screening
Diagnosis
Prevention

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Glomerulonephritis Main page
Glomerulonephritis patient information
Overview
Classification [[]] [[]] [[]]
Pathophysiology
Differential Diagnosis
Screening
Diagnosis
Prevention

Pathophysiology

Microscopic Pathology

Images shown below are courtesy of Professor Peter Anderson DVM PhD and published with permission © PEIR, University of Alabama at Birmingham, Department of Pathology

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  Glomerulonephritis: Micro H&E med mag; an excellent example of AGN with many neutrophils

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  Acute Glomerulonephritis: Micro H&E high mag; an excellent example of acute exudative glomerulonephritis.

Glomerulonephritis Videos

Rapidly progressive glomerulonephritis

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Chronic glomerulonephritis

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Images

Image courtesy of Professor Peter Anderson DVM PhD and published with permission © PEIR, University of Alabama at Birmingham, Department of Pathology

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  This is a low-power photomicrograph of a saggital section of end stage chronic glomerulonephritis (GN). Note the marked thinning of the cortex (arrow).

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  This is a higher-power photomicrograph of hyalinized glomeruli (arrows) and glomeruli with thick basement membranes.

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  This is a higher-power photomicrograph of hyalinized glomeruli (1) and glomeruli with thickened basement membranes (2).

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  This is a photomicrograph of interstitial and vascular lesions in end stage renal disease.

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  This is an immunofluorescent photomicrograph of granular membranous immunofluorescence (immune complex disease). The antibody used for these studies was specific for IgG.

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  This is an electron micrograph of subepithelial granular electron dense deposits (arrows) which correspond to the granular immunofluorescence seen in the previous image.

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  This is a photomicrograph of a glomerulus from another case with acute poststreptococcal glomerulonephritis. In this case the immune complex glomerular disease is ongoing with necrosis and accumulation of neutrophils in the glomerulus.

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  This immunofluorescent photomicrograph of a glomerulus from a case of acute poststreptococcal glomerulonephritis shows a granular immunofluorescence pattern consistent with immune complex disease. The primary antibody used for this staining was specific for IgG; however antibodies for complement would show a similar pattern.

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  This electron micrograph demonstrates scattered subepithelial dense deposits (arrows) and a polymorphonuclear leukocyte in the lumen.

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  For comparison this is an immunofluorescent photomicrograph of a glomerulus from a patient with Goodpasture's syndrome. The linear (arrows) immunofluorescence is characteristic of Goodpasture's syndrome.

Images:

• Crescentic GN

• Chronic GN

References

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Common Causes

• Churg-strauss syndrome
• Cryoglobulinaemia
• Diabetes mellitus type 2
• Dibasic aminoaciduria type 2
• Endocarditis
• Glycogenosis type 1a
• Henoch-schönlein purpura 
• Hepatitis b
• Hereditary onycho-osteodysplasia
• Hypersensitivity vasculitis
• Iga nephropathy
• Lepromatous leprosy
• Mixed essential cryoglobulinaemia
• Myeloma
• Paraneoplastic syndrome
• Polyarteritis nodosa
• Radiotherapy
• Schimke immunoosseous dysplasia
• Secondary syphilis
• Serum sickness
• Sickle cell disease
• Systemic lupus erythematosus
• Vasculitis
• Wegener's granulomatosis
• Wiskott-aldrich syndrome

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Glomerulonephritis Main page
Glomerulonephritis patient information
Overview
Classification [[]] [[]] [[]]
Pathophysiology
Differential Diagnosis
Screening
Diagnosis
Prevention

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [2]; Associate Editor(s)-in-Chief: Syed Hassan A. Kazmi BSc, MD [3]

Overview

Glomerulonephritis may be proliferative or non-proliferative and may be associated with nephrotic or nephritic features. The various types of glomerulonephritides should be differentiated from each other based on associations, presence of pitting edema, hemeturia, hypertension, hemoptysis, oliguria, peri-orbital edema, hyperlipidemia, type of antibodies, light and electron microscopic features.

Differential Diagnosis

The following table differentiates between various types of glomerulonephritides:

Glomerulonephritis	Sub-entity	Causes and associations	History and Symtoms							Laboratory Findings
										Hyperlipidemia and hypercholesterolemia	Nephrotic features	Nephritic features	ANCA	Anti-glomerular basement membrane antibody (Anti-GBM antibody)	Immune complex formation	Light microscope	Electron microscope	Immunoflourescence pattern
			History	Pitting edema	Hemeturia (pre-dominantly microscopic)	Hypertension	Hemoptysis	Oliguria	Peri-orbital edema
Non-proliferative	Minimal change disease	Idiopathic Protein tyrosine phosphatase receptor type O (glomerular epithelial protein 1- GLEPP1)	Young children Recent infection and immunization Atopy Hodgkin lymphoma Thrombosis (due to urinary loss of antithrombin-III)	+	-	-	-	+/-	-	+	+	-	-	-	-	Normal	Fusion of podocytes	-
	Focal segmental glomerulosclerosis	Idiopathic HIV Heroine use Sickle cell disease Interferon Severe obesity Mixed cryoglobunemia (Hepatitis C)	Adults	+	-	-	-	+/-	-	+	+	-	-	-	-	Focal (some glomeruli) and segmental (only part of glomerulus)	Effacement of podocytes	-
	Membranous glomerulonephritis	Idiopathic Hepatitis B and C Solid tumors Systemic lupus erythmatosus Drugs (NSAIDS, penclliamine, gold, captopril)		+	-	-	-	+/-	-	+	+	-	-	-	+	Thick glomerular basement membrance	Sub-epithelial immune complex depositis with 'spike and dome' appearance	-
Proliferative	IgA nephropathy	Idiopathic Viral infections	Young children History of mucosal infections (e.g. gastroenteritis) and upper respiratory tract infection 2-3 days after infection (synpharyngitic)	+/-	+	+	-	+	+/-	-	-	+	-	-	+	Crescent formation	Mesangial proliferation	-
	Rapidly progressive glomerulonephritis	Goodpasture syndrome	Young adults	+/-	+	+	+	+	+	-	-	+	-	+	+	Hypercellular and inflamed glomeruli (Crescent formation)	Diffuse thickening of the glomerular basement membrane with absence of subepithelial and subendothelial deposits	+ (Linear)
		Post infectious glomerulonephritis	Streptococcal skin infections Streptococcal pharyngitis 2-3 weeks after infection	+/-	+	+	+	+	+	-	-	+	-	-	+	Hypercellular and inflamed glomeruli	Sub-epithelial immune complex deposits	+ (Granular)
		Granulomatosis with polyangitis (Wegner's granulomatosis)	Necrotizing granulomas (Nasopharynx, lungs, kidneys) Conjunctivitis Ulceration of the cornea Episcleritis Peripheral neuropathy	+/-	+	+	+	+	+	-	-	+	+ (C-ANCA)	-	-	Hypercellular and inflamed glomeruli (Crescent formation)	- (pauci-immune)	+/-
		Churg Strauss syndrome	Necrotizing granulomas (Lungs and kidneys) Asthma Peripheral neuropathy	+/-	+	+	+	+	+	-	-	+	+ (C-ANCA)	-	-	Hypercellular and inflamed glomeruli (Crescent formation)	- (pauci-immune)	-
		Microscopic polyngitis	Necrotizing vasculitis (no granuloma)	+/-	+	+	+	+	+	-	-	+	+ (P-ANCA)	-	-	Hypercellular and inflamed glomeruli (Crescent formation)	- (pauci-immune)	-
	Membranoproliferative glomerulonephritis	Idiopathic Hepatitis B and C (Type 1) C3 nepritic factor (Type2)	Hemeturia Oliguria Periorbital edema Hypertension	+/-	+	+	+	+	+	-	+	-	-	-	+	Thick glomerular basement membrane (Tram-track appearance)	Mesangial proliferation and leukocyte infiltration	+ (Granular)

References