2.5 Summary of Major Primary Glomerulonephritides

Question 1

Disease:
Clinical Presentation: Nephritic Syndrome
Pathogenesis: Immune complex mediated; circulating or planted antigen
LM: Diffuse endocapillary proliferation; leukocytic infiltration
IF: Granular IgG and C3 in GBM and mesangium; granular IgA in some cases
EM: Primarily subepithelial humps; subendothelial deposits in early disease stages

Answer 1

Postinfectious Glomerulonephritis

Question 2

Disease:
Clinical Presentation: Rapidly progressive GN
Pathogenesis: Anti GBM COL4-A3 antigen
LM: Extracapillary proliferation with crescents & necrosis
IF: Linear IgG and C3; fibrin in crescents
EM: No deposits; GBM disruptions ; fibrin

Answer 2

Goodpasture Syndrome

Question 3

Disease:
Clinical Presentation: Chornic renal failure
Pathogenesis: Variable
LM: Hyalinzed glomeruli
IF: Granular or negative
EM: none

Answer 3

Chronic glomerulonephritis

Question 4

Disease:
Clinical Presentation: Nephrotic syndrome
Pathogenesis: in situ complex formation; PLA2R antigen
LM: Diffuse capillary wall thickening
IF: Granular IgG and C3; diffuse
EM: Subepithelial deposits

Answer 4

Membranous nephropathy

Question 5

Disease:
Clinical Presentation: Nephrotic syndrome
Pathogenesis: Unknown; loss of glomerular polyanion; podocyte injury
LM: Normal; lipid in tubules
IF: Negative
EM: Loss of foot podocytes; no deposits

Answer 5

Minimal Change Disease

Question 6

Disease:
Clinical Presentation: Nephrotic syndrome; nonnephrotic proteinuria (MIXED)
Pathogenesis: Unknown; ablation nephropathy; plasma factor; podocyte injury
LM: focal and segmental sclerosis and hyalinosis
IF:Focal; IgM+ C3 in many cases
EM: Loss foot processes; epithelial denudation

Answer 6

Focal segmental glomerulosclerosis FSGS

Question 7

Disease:
Clinical Presentation: Nephrotic/Nephritic syndrome
Pathogenesis: Immune complex
LM: Mesangial proliferative or membranoproliferative patterns of proliferation; GBM thickening;splitting
IF: IgG ++C3; C1q++C4
EM: Subendothelial deposits

Answer 7

Membranoproliferative glomerulonephritis (MPGN) Type 1

Question 8

Disease:
Clinical Presentation: Hematuria & chronic renal failure
Pathogenesis: Autoantibody; alternative complement pathway
LM: Mesangial proliferative or membranoproliferative patterns of proliferation; GBM thickening and splitting
IF: C3; no C1q or C4*
EM: Dense Deposits

Answer 8

Dense-deposit disease (MPGN) Type 2

Question 9

Disease:
Clinical Presentation: Recurrent hematuria** (or proteinuria)
Pathogenesis: Unknown
LM: Focal mesangial proliferative glomerulonephritis; mesangial widening
IF: IgA +/- IgG, IgM, and C3 in mesangium*
EM: Mesangial and paramesangial dense deposits

Answer 9

IgA Nepropathy