The Spectrum of Glomerulonephritis txt

This is the low-bandwidth, text alternative to the video The Spectrum of Glomerulonephritis  and from the post The Spectrum of Glomerulonephritis.

Neil Turner – Nov 2020

So this is a short talk about a range of problems that glomerula injury can cause and the ways in which that helps you to understand which disease is causing the trouble.

Remembering that the glomerulus has just three cell types and a fairly stereotyped way of responding to the different things that can damage it.

It’s really useful to think of kidney diseases, glomerular diseases as on a spectrum like this with at the left hand and end here lots of proteinuria or no hematuria. And at the right-hand here lots of hematuria and just a tiny bit or no proteinuria.

The diseases at the left-hand end, that cause proteinuria are associated with injury to podocytes. Either direct injury or creating an unhappy environment for podocytes by changing the architecture of the glomerulus. You can change the architecture of the glomerulus by depositing materials in the glomerulus that shouldn’t normally be there. Or by scarring caused by inflammation or similar damage to the glomerulus itself.

The picture here shows diabetic nephropathy, where there’s huge amounts of this pink material deposited. You can easily see that’s going to be an unfavorable environment for those beautifully refined developed cells.

At the right-hand end, these are the inflammatory diseases. Remember these have to break holes and the glomerular basement membrane to allow blood to get down into the urine. And they should rightly be called hematuric rather than nephritic, because nephritic has a particular sense but in these diseases there’s inflammation and you can see the cells of the inflammatory system in here, the immune system and also the proliferating cells of the glomerulus itself trying to repair the damage that’s been caused.

So these are destructive processes that lead to holes in the GBM and you can see all these signs, with the right stains and at high power you’ll see breaks in the glomerular basement membrane that allows blood cells to get into the urine. And in some contexts, you’ll see these crescents being formed between about three o’clock and eight clock here there’s a crescent.

Now, all the diseases that anyone might ask you about in exams are spread somewhere along this spectrum.

The Spectrum of glomerular diseases

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At the left-hand end here you have the three plus two diseases that cause nephrotic syndrome, severe protein leak diseases without much in the way of haematuria at all.

At the right-hand end other diseases that cause hematuria and some of these will hit on very rapidly and very rapidly cause severe renal damage in some of them, much more slow. A couple of diseases, it’s really difficult to put in a single point.

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This one here always causes haematuria but can cause a whole variety of things in addition to that.	This one at the top can cause absolutely anything at once.

So that’s the spectrum of glomerular diseases.

And the next thing to do is to look first at the diseases that cause proteinuria and nephrotic syndrome.	Click here for a larger image
And secondly, at the diseases that cause hematuria and sometimes nephritic syndrome and rapid kidney destruction	Click here for a larger image

 

More like this – medcal.mvm.ed.ac.uk – Renal