Rapidly Progrssive GN:

*Severe and usally loss of more than 50% of GFR in 3mo

*Crecenteric
*Proliferation of epithelial cells with occlusion of Bowmans space and compression of
the tuft
NEPHROTIC SYNDROME:
NEPHRITIC SYNDROME:
-Protenuria : MORE than 3.5
-Hematuria
-Hypoalbuminemia: LESS than 2.5
-HTN
-Hypercholesterolemia: MORE than 200
-Renal Insuff
-Edema
- Edema
*Minimal Change (+ common kids)
*IGA (+ common adults)
*Membranous Nephropathy (+ common adults)
*A. Post Step GN (+ common kids)
*Focal Segmental Glomerulosclerosis (black kids/adults)
*Alport
*Membranoproliferative Glomerulonephritis
*SLE
*IGA
*MPGN (only kids)
*Diabetes (only adults)
*Good Pastures (only adults)
*Vasculitis
-(h. purpura-only kids)

NEPHROTIC SYNDROME:
1. Minimal Change Nephrotic Syndrome:
Most common cause in CHILDREN
nephritic feautures absent
RESPONSE TO STEROIDS (: and excellent prognosis; 85% in remission
HISTO: effacement of podocytes
SECONDARY CAUSES:
-drugs (nsaids/penicillin)
-toxins (mercury/lead/ bee stings)
-infections (malaria)
-tumors (Hodgkins lymphoma)
2. Focal Segmental Glomerulosclerosis:
Most common cause in BLACK & TEENS
Primary no known cause
Familial
o Podocin mutations (NPHS2) -> steroid resistant
o Alfa actinin 4 mutations (ACTn4) -> AD familial
Secondary:
o Hiv
o Heroin
o Sickle Cell
Nephritic features y HTN
Most are steroid resistant :/
More than 50% -> end stage renal disease
HISTO: segmental scelerosis (se ve bn grueso)
3. Membranous Nephropathy:
+ common cause in ADULTS
MASSIVE proteinuria
HISTO:
o thick cap walls and spikes on silver stain
o subendothelial deposits
o looks granular en immunofluorescence
Secondary:
o HEP B
o SLE
o Malignancies
o Drugs (gold, pencillin, captopril)
4. Membranoproliferative:
Both nephrotic-nephritic features
HISTO: nodular appearance of glomerulus; subendo deposits
Low complemtent (C3)

EXTRA RENLAL COMPLICATIONS OF NEPHROTIC SYNDROME:

Loose antithrombin 3 y se acumulan los coagulation factors:
HYPERCOAGULABILITY
Loose thyroglobulin and thyroid binding globulin: HYPOTHYRODISM
Loose Vit D : VIT D DEFICIENCY
Increased Synthesis of lipids and decreased LCAT and LPL: HYPERLIPIDEMIA
Loose Igs : INFECTIONS
NEPRHRITIC Syndrome:
1. Acute Post Strep Glomerulonephritis:
School aged CHILDREN
1-2 week after pharynits(respi) or 2-3 weeks after impetigo (skin)
b hemolytic STREP (strep pyogenes)
excellent prognosis
Histo:
o glomerulo cn muchas celulas (hypercellular)
o subendothelial humps en EM

Pathophys:
o se active el complement (ALTERNATE pathway) cuando los
complejos antigen-anticuerpo se depositan en la membrane
o antibodies attack el mismo strep antigen que se pega al glomerulo
i.e. planted antigen(so estos antibodies atacan the EXOGENOUS
step antigen pegado al glomerulo)

2. IG A Nephropathy:

Most common nephropathy in the world!

SIMULTANEOUS with respiratory infection
Excellent Prognosis
HISTO: really thick mesangium

3. Good Pastures:
Pulmonary-Renal Syndrome
Antibodies against: TYPE 4 COLL alpha 3 chain
CLINICAL: hematuria/proteinuria/ RPGN/ cough /hemoptysis/ fatigue
TEST: anti GMB antibodies
HISTO: linear Ig G deposits along GBM