Most cases of this GN are sub clinical
Post Infectious GN
LM shows:
- exudative proliferative GN
- diffuse glomerular hypercellularity,
- abundant inflammatory cells
- mesangial and endothelial cell proliferation
- sometimes crescents
Post Infectious GN
IF shows:
- Granular C3 (always glomerular) & IgG
- “Starry Sky” or “Garland” pattern
Post Infectious GN
EM shows:
- Subepithelial “humps”
Post Infectious GN
Caused by nephritogenic strains of group A beta-hemolytic Streptococcus (GAS)
Post Infectious GN
Activates the alternate or lectin pathway for complements (hence normal c4)
Post Infectious GN
- Large vessel vasculitis
- Granulamtous
- ANCA negative
Takayasu’s artertitis
- Medium vessel vasculitis
- Not granulomatous
- Can be necrotizing (but not in glom’s)
- ANCA negative
Polyarteritis nodosa or kawasaki disease
- Pauci-immune
- granulomatous
- p-ANCA/MPO
Churg-Strauss Syndrome
- Pauci-immune
- granulomatous
- c-ANCA/PR3
Granulomatosis with polyangiitis (Wegeners’)
- Pauci-immune
- Not granulomatous
- p-ANCA/MPO
Microscopic Polyangiitis
- Leukocytoclastic
- Immune complex (IgA)
HSP
- Immune complex deposits
- Negative ANCA’s
SLE
LM can be variable but shows:
- mesangial proliferation vs. normal
HSP
IF shows:
- Granular, mesangial IgA
HSP
EM shows:
- Mesangial electron dense deposits
- Sometimes thinning of GBM
HSP
Skin biopsy shows leukoctyoclastic small-vessel vasculitis with IgA deposits
HSP
Most common vasculitis in children (most cases < 10 years old)
HSP
How many of the following to diagnose lupus?
- malar rash
- discoid rash
- photosensitivity
- oral ulcers
- nonerosive arthritis
- serositis, pleuritis or pericarditis
- renal disease
- neurologic involvement
- hematologic involvement
- immunologic tests (anti-DS DNA, anti phospholipid, anti smith)
- positive ANA
4
What class of Lupus Nephritis:
- normal on LM
- few mesangial deposits on IF/EM
- normal UA
- no renal therapies needed
Class 1 (minimal mesangial)
What class of Lupus Nephritis:
- mesangial hypercellularity
- mesangial deposits
- no significant deposits or scarring
- microscopic hematuria and/or proteinruia
- normal renal function
- normal bp
- no renal therapies needed
Class 2 (mesangial proliferative)
What class of Lupus Nephritis:
- < 50% gloms show GN
- subendothelial & mesangial deposits
- hematuria, proteinuria
- can have hypertension, nephrotic syndrome, or elevated sCr
- tx depends on severity and activity vs. chronicity
Class 3 (focal)
What class of Lupus Nephritis:
- > 50% gloms show GN
- subendothelial & mesangial deposits
- hematuria, proteinuria
- can have hypertension, nephrotic syndrome, or elevated sCr
- tx depends on severity and activity vs. chronicity
Class 4 (diffuse)
What class of Lupus Nephritis:
- diffuse GBM thickening
- subepithelial & messangial deposits
- spikes
- similar to membranous nephropathy
- usually nephritic with little or no systemic SLE
- treat with cytoxan, azathioprine or mmf
Class 5 (membranous)
