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Class Category Histo Appearance Immunofluorescence Diseases Clinical SxRenal Angenesis Nephritic, Glomerular Hyperceulluarity

(neuts, epithelial,endothelial, andmesangial)

Poorly defined caploops

EM subepithelial(e-)-dense immunedeposits

Course granularity Lumpy bumpy IgG or C3

Post-strep infxn Lupus IV Infected valve Bacterial

endocarditis Some viral

infxns Overwhelming

sepsis

Hematuria Oliguria Azotemia HTN

Rapidly ProgressiveGlomerulonephritisdeposits of fibrin inBowmans space andparietal cellproliferationcrescents

Nephritic, Glomerular Epithelial crescentssquash gloms

Linear (b/c Ab isagainst entire BM)

IgG

RPGN I = Anti-GMB:Goodpastures(lung involvmenttoo)

RPGN II =immunecomplex dz +RPGN: post-

strep, bad Lupus RPGN III =vasculitis:Wegenerspolyarteritisnodosa

Hematuria Moderate-

severeproteinuria w/edema

Hemoptysis inGoodpastures

MesangialGlomerulonephritis

Glomerular Mesangial cellproliferation

EM immunedeposits inmesangium

Tree in winter Immune deposits in

mesangium

IgANephropathy(Bergers dz,see below)

Mild SLE Resolving post-

strep GN

Asymptomatichematuria

Mildproteinuria

MembranousGlomerulopathy most common causeof nephrotic syndromein adults

Nephrotic,Glomerular

Thick cap loops NO cellularity Small, evenly

spaced subepithelialdeposits GBMgrows up aroundthese spikesbuzz cut

Fine granularity IgG or C3

Lupus V Hep B and C Tubulopathies NSAID use Cancer Idiopathic Experimental

Heymanns

Proteinuria Edema 50% get

chronic renalfailure

Minimal ChangeDisease loss of GMB

polyanions albumincan get thru

Nephrotic,Glomerular

Gloms look normalunder LM

EM fused footprocesses

No immune complexinvolvment

Seen mostly in kids Selectiveproteinuria

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Focal SegmentalGlomerulosclerosismore severe, criticalform of MCD seen inadults more than kids

Nephrotic Glomerular Stripe of fibrosisacross glom

EM fused footprocesses

Granular IgM and C3

Recurring intransplant pt.s

AIDS Heroin Reflux

nephropathy Hyperfiltration

(some glomshave to workovertime)

Non-selectiveproteinuria

Oliguria HTN Chronic renal

failure

MembranoproliferativeGN Type I immunecomplex deposits andactivation of classiccomplement

Nephritic/nephrotic,Glomerular

BM thickening Mesangial

proliferation M -like mesangial

cells send processesout to attackimmune complexesbut split BM tram

tracks

Course granularity IgG, C3, C4, C1q

Idiopathic (haveC3 nephriticfactor)

Asymptomatichematuria

Fat depositsdisappearfromeverywhereexcept legs

serum C3

MembranoproliferativeGN Type II

Nephritic/nephrotic,Glomerular

Tram tracks liketype I

EM dense depositsin BM coalesce intoribbon-like mass

Worms Only C3 stains

Dense deposit dz serum C3

IgA Nephropathy IgAdeposited inmesangium; mostcommon form of glomerulonephritis

Sometimes enoughproteinuria to beclassified asnephrotic,Glomerular

IgA desposited inmesangiummesangialproliferation

Tree in wintersame as mesangialstaining

Can beassociated w/Henoch-Schonleinpurpura:purpuric dermallesions and non-migratoryarthralgias

Usually seenin young men

serum IgA Gross

hematuria HTN

SLE Nephrotic/nephritic,Glomerular

Crescents:proliferatingepithelial cells

Wire loops:subendothelialimmune complexes

Thick GBM

Course granularity Sometimes mixed

Type I: no renalinvolvement

II: mesangialform

III: focalproliferativeform

IV: diffuse

proliferativeform

The usual crazyLupus story

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V: membranousform

DiabeticGlomerulosclerosis

Glomerular Thick GBM Mesangial matrix Nondular

glomerulosclerosis(Kimmelstiel-Wilson): pinkhyaline in in caploops

Thickened/hyalinized afferent andefferent arteriole

DM Albuminuria