ACUTE NEPHROTIC SYNDROME

RAPIDLY PROGRESSIVE GLOMERULONEPHRITIS

PATHOGENESIS

Definition: a clinicopathological syndrome, clinically by rapid &

progressive loss of renal function associated with severe oliguria leading
to acute renal failure. Histologically, by presence of crescents in more
than 50% of glomeruli.

acute glomerular injury. Lesions have proliferation of endocapillary

cellularity(mesangial & endothelial cell) and leukocytic infiltration.
-inflammatory reaction injures capillary wall, permit escape of RBC &
protein in urine

PATHOGENESIS

- mesangial cellularity compress capillary lumina induce haemodynamic

changes leading to reduced GFR. Manifested by oliguria with fluid
retention & azotemia

Injury of capillary wall escape of plasma protein, fibrin, & inflammatory

cell to Bowmans capsule. This causes proliferation of parietal cell of
glomerular capsule together with infiltration of interstitium by
macrophages & interstitial fibroblast cresent formation. Cresents
eventually obliterate Bowmans space & compress glomeruli.

-hypertension result from fluid retention & renin release from ischemic
kidney.
CAUSES OF NEPHROTIC SYNDROME
1. 1ry glomerular disease
-infection:
Post-streptococcal GN
Non-streptococcal GN (certain pneumococcal &
stapylococcal infections, some viral infections as HCV and
HBV)
2. 2ry to systemic disease

In some cases,
Injury of glomerular capillary wall + injury of pulmonary alveolar
basement membrane wall(due to formation of anti-GBM Ab that cross
react with alveolar basement membrane)

Clinical picture:
Pulmonary haemorrhage with haemoptysis and acute renal failure
(Goodpasture syndrome)
IF: deposits of Ig G/Ig M and complement along capillary wall of kidney
and alveoli wall(Linear pattern)