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2 TYPES
o Primary glomerular lesions
The kidney is the prime target.
o Secondary glomerular lesions
The glomerular injury is secondary to events elsewhere in the body.
CAUSES
o Immunological reactions
o Non-immunological disorders
- Diabetes mellitus
- Hypertension
- SLE
- Haemolytic uraemic syndrome
RENAL BIOPSY
H AND E STAINING
SPECIAL STAINS = PAS , SILVER AND MASSONS TRICHROME
ELECTRON MICROSCOPY
o Shows deposited immune complexes = subepithelial, subendothelial ,mesangeal
IMMUNOFLUORESCENCE
o Detects deposition of immunoglobulin
PROLIFERATIVE
o Increased no of cells within glomerulus
Due to proliferation of indigenous cells
Recruitment of polymorphs and macrophage from circulation
MEMBRANOUS CHANGE
o Peripheral loops thickened due to basement membrane expansion
MEMBRANO-PROLIFERATIVE
o Proliferative + membranous changes with accentuation of lobular architecture
CRESCENTIC
o Proliferation of cells including macrophages lining bowman’s capsule = compresses the glomerulus
a. post-infectious/streptococcal glomerulonephritis
i. More commonly occurring = due to deposition of immune complex leading to diffuse proliferative GN
ii. Other causative organisms = pneumococcal infections, staph, viral like mumps, measles , chicken pox, hep b
and c
iii. Common scenario /classic
1. In a child 1-4 weeks after recovery from a group A streptococcal infection ( initial infection = skin or
pharynx)
iv. Clinical course
1. Abrupt onset = malaise, slight fever, nausea and nephritic syndrome
2. Mild –moderate= oliguria , azotemia and htn
3. Characteristics = gross hematuria with smoky brown urine rather than bright red
4. Constant feature = some proteinuria. Might be severe enough to produce nephrotic syndrome
5. Serum anti-streptolysin O antibody titers are elevated in post streptococcal cases
v. MOrpholgy
1. Diffuse glomerular involvement
2. Increased cellularity due to
a. Proliferation and swelling of endothelial and mesangial cells
b. Neutrophilic and monocyctic infiltrate
vi. RECOVERY
1. Occurs in most children
2. Some develop rapidly progressive GN due to severe injury with crescents or chronic renal disease
due to secondary scarring
Tubulointerstitial
TUBULOINTERSTITIAL NEPHRITIS
o TOXINS
Causes = heavy metals organic solvents glycol therapeutic substances ( antibiotics, nsaids, diuretics,
anesthesics, paraquat, phenol , pesticides
Morphology
Red and swollen
SAME AS ISCHEMIC BUT damage is more in proximal tubular cells and distal tubule spared
RENAL STONES
Risk factors
o Men
o Familial tendency
Occurs anywhere in tract = commonest = renal pelvis
CALCULI FORMS EITHER DUE TO
o Substances in excess= supersaturation
o Lack of substances that normally inhibit mineral precipitation
Substances in urine that normally inhibit precipitation of crystals = tamm horsfall protein ,
pyrophosphates, citrates
o PH OF URINE
HIGH PH = calcium phosphate and struviate stones
LOW = uric acid
Types of stones
o CALCIUM OXALATE / CALCIUM PHOSPHATE ( 80% stones)
Idiopathic hypercalciuria (50%)
Hypercalcemia and hypercalciuria (10%)
Hyperoxaluria (5%)
Hyperuricosuria (20%)
No known metabolic abnormality (15% to 20%)
o STRUVITE ( Mg, NH3, Ca, PO4)
Renal infection
o URIC ACID
Hyperuricemia
Hyperuricosuria
Idiopathic (50% of uric acid stones)
o CYSTINE
Clinical features
o Asymptomatic
o Dull ache in the loins
o Renal colic (due to the passage of a small stone along the ureter)
o Recurrent urinary tract infection.
MORPHOLOGY
o Stones are unilateral in about 80% of patients
o Common sites
Renal pelvis and calyces
Bladder
o Staghorn calculi = cast of renal pelvis and calyces
Made up of magnesium ammonium phosphate
MORPHOLOGY