GLOMERULAR DISEASE
Glomerular Disease
MECHANISMS OF IMMUNE MEDIATED GD
AB BIND AG IN GLOMERULR BASEMENT MEMBRANE & ACTIVATES COMPLEMENT.
CIRCULATING AG/AB COMPLEXES DEPOSIT ON GLOMERULUS & ACTIVATE COMPLEMENT
Clinical Syndromes
Nephritic
OLIGURIA
Due to decrease in renal function
MILD HPT
RED CELL CASTS
HAEMATURIA
Occurs bcoz podocytes develop large pores that cause leakage of protein & blood cells into urine.
Renal Failure
Nephrotic
FROTHY URINE
FLUID MOVES FROM INTRAVASCULAR COMPARTMENT TO SURROUNDING TISSUES = OEDEMA
HYPOALBUMINAEMIA
LIver compensate & increases production but this comes with increase in production in lipids= hyperlipidaemia
Glomerular filtration is impaired, thus gaps in podocytes allow this protein to be filtered & lost in urine.
INTRAVASCULAR ONCOTIC PRESSURE DECREASES
PROTEINURIA
GLOMERULONEPHRITIS
INFLAMMATION & DAMAGE TO GLOMERULUS
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ACUTE PROLIF. GN
Microscopically:
Post infection usually GAS infections
CRESCENTIC
Membranous
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Neutrophils
Mesengial & endothelial proliferation
Enlarged Glomeruli
Acute GN
KIDNEY WILL BE:
PALE
OEDEMATOUS
LARGE
CHRONIC GN
KIDNEY WILL BE:
GRANULAR
SMALL
Proliferation of cells in Bowman's space.
Rapidly progessive & poor prognosis
Any GN can progress to this form
TYPES
2. Immune Complex
3. Pauci-Immune
1. Anti-GBM Antibdy
Goodpasture syndrome
Idiopathic
Antibodies directed against glomerular basement membrane
Immune mediated disease
Post infection
Systemic lupus erythematous (SLE)
Idiopathic
IgA Nephropathy
No ag/ab complex depositions
Linear in immunofluorescent
Granular in immunofluorescent
Negative in immunofluorescent
Associated with Antineutrophils cytoplasmic antibodies(ANCA)
Wegner granulomatosis
Vasculiltis caused by ANCA
3 Stages:
**Cellular( Reversible)
Fibrocellular
Fibrosed(irreversible)**
Glomeruli necrosed & collapsed
Ag deposits then Ab comes to bind to it & cause inflammatory response.
Aetiologies
Parasites
Drug Therapy
Infection
Neoplasms
Autoimmune
Causes leaky membranes
Thickened Glomerular basement membrane
The mechanism that ties all these glomerular diseases together is proliferation of the cells within the glomeruli, along with inflammation in the glomerulus. The inflammatory cells damage capillary walls, allowing red cells to leak out. It’s harder to pump blood through the glomerulus when it’s all stuffed full of cells, so the glomerular filtration rate goes down (leading to oliguria).