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Glomerulonephritis definition , mechanism and clinical presentation (Syndromes)

Glomerulonephritis or Glomerulonephritides is a serious renal case which has different presentations .
In this article we are going to illustrate the mechanism and the known presentations ( syndromes ) of G.N


Definition:
 Glomerulonephritis is an immune mediated glomerular injury with symmetrical simultaneous involvement of both kidneys at the same time.
Glomerulonephritis

Mechanism of glomerular injury:

• Circulating Immune complex.
• In situ formation of immune complex.
• Antiglomerular basement membrane antibody (anti-GBM) e.g. Good pasture syndrome.
The above mechanisms activate secondary mechanisms that produce glomerular damage.

Secondary mechanisms of glomerular injury

• Complement activation.
• Fibrin deposition.
• Platelet aggregation.
• Activation of kinin system.
• Inflammation with neutrophil dependent mechanisms.

Immune complex or anti GBM antibody deposttion trigger the above secondary mechanisms resulting in an increase in capillary permeability and
glomerular damage .

Glomerular Syndromes ( Presentations of Glomerulonephritis )

a. Acute Nephritic syndrome 

Nephronal hematuria (RBC casts and/or dysrnorphlc RBCs) temporarily associated with renal impairment or acute renal failure.

b. Nephrotic syndrome 

Heavy proteinuria( > 3.5 gm/D/1.73m2).
- It may be pure nephrotic syndrome with bland sediment or mixed nephrotic / nephritic syndrome with active sediment

c. Rapidly Progressive Glomerulonephritis

progressive Glomerulonephritis

Nephronal hematuria (RBCs cast and / or dysmorphic RBCs) with renal failure developing over weeks to months and diffuse glomerular crescents.

d. Asymptomatic urinary  abnormalities:

- Isolated proteinuria ( < 2 gm/D/1.73m2).
- Hematuria (with or without proteinuria) e.g. in IgA nephropathy and Alpert's syndrome.

e. Chronic Glomerulonephritis
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Tamer Mobarak

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