TABLE 20-5 -- Summary of Major Primary Glomerulonephritides Glomerular Pathology Fluorescen Most Frequent ce Clinical Light Microscop Electron

Disease Presentation Pathogenesis Microscopy y Microscopy Postinfectious Nephritic glomerulonephritis syndrome Immune complex mediated; circulating or planted antigen Diffuse endocapillary proliferation; leukocytic infiltration Extracapillary proliferation with crescents; necrosis Hyalinized glomeruli Granular Subepithelial IgG and C3 humps in GBM and mesangium Linear IgG and C3; fibrin in crescents Granular or negative No deposits; GBM disruptions; fibrin

Goodpasture syndrome

Rapidly Anti-GBM progressive COL4-A3 glomerulonephriti antigen s Variable

Chronic Chronic renal glomerulonephritis failure Membranous glomerulopathy Nephrotic syndrome

In situ immune Diffuse capillary Granular Subepithelial complex wall thickening IgG and C3; deposits formation; diffuse antigens mostly unknown Unknown; loss Normal; lipid in Negative of glomerular tubules polyanion; podocyte injury Focal and segmental Ablation sclerosis and nephropath hyalinosis y Unknown Plasma factor (?); podocyte injury Loss of foot processes; no deposits

Minimal-change disease

Nephrotic syndrome

Focal segmental Nephrotic glomerulosclerosis syndrome; nonnephrotic proteinuria

Focal; IgM +Loss of foot C3 processes; epithelial denudation

Membranoprolifer Nephrotic/nephrot Immune ative ic syndrome complex glomerulonephritis (MPGN) type I Dense-deposit disease (MPGN type II) Autoantibody; alternative Chronic renal complement failure pathway Hematuria Recurrent hematuria or proteinuria Unknown

IgG + C3; C1q + C4

Subendotheli al deposits

Mesangial and C3IgG; no Dense endocapillary C1q or C4 deposits proliferation; GBM thickening; splitting Focal mesangial IgAIgG, Mesangial proliferative IgM, and C3 and glomerulonephrit in paramesangi is; mesangial mesangium al dense

IgA nephropathy

Disease

Most Frequent Clinical Presentation

Glomerular Pathology Fluorescen ce Light Microscop Electron Pathogenesis Microscopy y Microscopy widening deposits

GBM, glomerular basement membrane.