Enumerate four major primary glomerulonephritides presenting with nephrotic syndrome. Describe pathogenesis, light microscopic, immunofluorescence microscopy and electron microscopic findings of post-infectious glomerulonephritis.
Major Primary Glomerulonephritides Presenting with Nephrotic Syndrome:
Minimal Change Disease (MCD): Most common in children; podocyte effacement on electron microscopy; normal light microscopy.
Focal Segmental Glomerulosclerosis (FSGS): Segmental sclerosis of some glomeruli; can be primary or secondary; podocyte injury is central.
Membranous Nephropathy (MN): Thickened glomerular basement membrane; subepithelial immune deposits; often autoimmune or secondary to infections/drugs.
Membranoproliferative Glomerulonephritis (MPGN): Mesangial proliferation with capillary wall thickening; immune complex or complement-mediated.
Post-Infectious Glomerulonephritis (PIGN): Often post Group A β-hemolytic Streptococcus infection after 1–4 weeks; immune complexes deposit in glomeruli, activating complement and recruiting inflammatory cells.
Microscopic Findings:
Light Microscopy: Diffuse glomerular proliferation with neutrophil and monocyte infiltration; capillary loops may be occluded.
Immunofluorescence: Granular IgG, IgM, and C3 deposits (“lumpy-bumpy”) in mesangium and capillary walls.
Electron Microscopy: Subepithelial electron-dense deposits forming characteristic “humps” on the glomerular basement membrane.
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