Glomerulonephritis

Clinic

• GN is an entity which is charactrized with inflammation of the glomerulus
• Glomerulus is functional unit of kidney which filters blood and generate urine

Sign/ Symptoms

• Nephrotic syndrome:
  • Edema due to Proteinuria
  • Hyperlipidemia is thought to be a result of the increased activity of the liver.
• Nephritic syndrome
  • Hematuria
  • Decrease in the amount of urine
  • Hypertension due to Renin–angiotensin system hyper activation.

Types

• GN is categorized into
  • Non-proliferative
  • Proliferative types

Causes

• Bacterial: GABHS
• Viral: HBV, HCV
• Parasitic pathogens
• SLE
• Vasculitis
• Diabetes

Tissue Salt Remedies

• NM: Nephritis + Hematuria (Nephritic syndrome)
• KS: Nephrotic syndrome: Fever + Proteinuria due to Erysipelas (GAHBS)
• KP: Proteinuria (Nephrotic syndrome) following scarlet fever

Miasms

Types

• Nonproliferativ which usually result in the nephrotic syndrome. Causes include:
  • Minimal change disease
  • Focal segmental glomerulosclerosis
  • Membranous glomerulonephritis
  • Thin basement membrane disease
  • Fibronectin glomerulopathy
• Proliferative
  • IgA nephropathy
  • Post-infectious: It classically occurs after infection with the bacteria Streptococcus pyogenes.
• Membranoproliferative: Also known as mesangiocapillary glomerulonephritis, is characterised by an increase in the number of cells in the glomerulus, and alterations in the glomerular basement membrane. These forms present with the nephritic syndrome, hypocomplementemia, and have a poor prognosis. Three subtypes:
  • Type 1 MPGN is caused by immune complex deposition in the mesangium and subendothelial space, typically secondary to SLE, HBV and HCV, or other chronic or recurring infections. Circulating immune complexes may activate the complement system, leading to inflammation and an influx of inflammatory cells.
  • Type 2 MPGN, also known as Dense Deposit Disease, is characterized by an excessive activation of the complement system. The C3 Nephritic Factor autoantibody stabilizes C3-convertase, which may lead to an excessive activation of complement. Type 2 MPGN is a subgroup of C3 glomerulopathy, a newly proposed diagnosis which also encompasses C3 Glomerulonephritis (C3GN).
  • Type 3 MPGN, which is caused by immune complex deposition in the subepithelial space.

• Rapidly progressive glomerulonephritis

• Crescentic glomerulonephritis induced by infective endocarditis on PAS staining and immunofluorescence. PAS staining (left) demonstrated circumferential and cellular crescent formation with interstitial nephritis. Immunofluorescence (right) demonstrated C3 positive staining in mesangial area. Also known as crescentic GN, is characterized by a rapid, progressive deterioration in kidney function. They may present with a nephritic syndrome and has Three main subtypes:
  • Goodpasture syndrome, an autoimmune disease also affecting the lung. In Goodpasture syndrome, IgG antibodies directed against the glomerular basement membrane trigger an inflammatory reaction, causing a nephritic syndrome and the coughing up of blood.
  • Immune-complex-mediated damage, and may be associated with SLE, post-infective glomerulonephritis, IgA nephropathy, and IgA vasculitis
  • Also called pauciimmune type, is associated with causes of vascular inflammation including
    1. Granulomatosis with polyangiitis (GPA) and
    2. Microscopic polyangiitis. No immune deposits can be seen on staining, however blood tests may be positive for the ANCA antibody.