Nephrotic Syndrome

 Nephrotic Syndrome

 Membranous glomerulopathy

• chronic immune complex mediated disease
• autoantibody to antigen on podocytes
• complement activated - injures epithelial cells
• little inflammation
• histology
• thickened basement membranes
• normal cellularity
• membranous "spikes" are basement membrane response to injury
• IgG and C3 deposition
• electron microscopy
• electron dense deposits in sub-epithelial components
• spikes between deposits
• clinical course
• increasing sclerosis
• non-selective proteinuria (which is mainly albumin)

Membranoproliferative glomerulonephritis

• proliferation of glomerular cells
• leukocyte infiltration (mainly in mesangium)
• Type I (secondary)
• most cases secondary to Hepatitis C
• other causes of ongoing immune complex production 
• histology
• capillary wall double lines (tram tracks)
• old basement membrane + deposits + new basement membrane
• open capillary loops that are thickened
• proliferation of mesangium
• immuneflourescence - C3 in sub-endothelial deposits
• clinical course
• nephrotic syndrome (may have some nephritic)
• few spontaneous remission, slow progression
• treatment not effective
• may recur in transplanted kidney
• cryoglobulins
• one cause of MPGN
• usually Hep C
• precipitate in capillary loops

Diabetic Nephropathy

• affects all 4 cellular compartments
• proteinuria in 50% of diabetics (I and II)
• microalbuminuria (30-300 mg/day) = increased GFR
• later development of macroalbuminuria

• GBM thickening
• Kimmelstiel-Wilson Disease
• long term diabetes
• nodular glomerulosclerosis
• increase in mesangial matrix but not cells
• accumulation of fibrin in capillary loops
• interstitial fibrosis and tubular atrophy
• microvascular damage/arteriole hyalinosis
•  systemic macro and microvascular disease