Nephritic syndrome

Nephritic syndrome

1. Clinical manifestations

   • Mild edema
   • grossly visible hematuria
     • Dysmorphic RBCs + red cells cast
   • hypertension
     • Due to fluid retention and renin release
   • abnormal renal function

2. Acute post-infectious glomerulonephritis

   • caused by glomerular deposition of immune complexes
   • resulting in proliferation of glomerular cells and infiltration of leukocytes, especially neutrophils.
   • large hump-shaped sub-epithelial deposits
   • global exudative proliferation, endocapillary proliferation, and numerous neutrophils.
   • Endocapillary proliferation ,PMNs both within capillary loops mesangial area
   • scattered granular deposits of IgG and complement
     • extensive garland pattern with elongated peripheral loop deposits

3. Membranoproliferative glomerulonephritis

   • endocapillary proliferation and glomerular basement membrane splitting, due to mesangial and subendothelial deposits,
   • MPGN type I
     • . diffuse endocapillary proliferation results in a lobular, uniform appearance of glomeruli
     • segmental interposition of cells, subendothelial deposits
       • which splitting of peripheral capillary GBM
     • sub-endothelial immune complexes (deposits)
       • addition to IgG, chunky peripheral loop deposits
     • Association: HBV, HBC2 and SLE
   • Type 2 MPGN "DDD"
     • global mesangial and often endocapillary proliferation
     • dense transformation of the GBM
     • Granular C3 is present

4. IgA nephropathy

   • mesangial cell and matrix increase, mesangial deposits.
   • Definitive diagnosis showing IgA in mesangial pattern
   • affects children, begins as episode of gross hematuria
   • confirms the presence of electron dense deposits in the mesangium