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Forms of glomerulonephritis
Last reviewed: 23.04.2024
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Today, the classification of glomerulonephritis, as before, is based on the features of the morphological picture. There are several forms (variants) of histological damage that are observed in the study of renal biopsy with the help of light, immunofluorescence and electron microscopy. This classification of glomerulonephritis does not seem ideal, as it does not have a unique relationship between the morphological picture, the clinic, the etiology and pathogenesis of glomerulonephritis: the same histological variant may have a different etiology and a different clinical picture. Moreover, the same etiology can cause a number of histological variants of glomerulonephritis (for example, a number of histological forms observed in viral hepatitis or systemic lupus erythematosus). Therefore, it is correct to consider each of these variants of renal biopsy not as an "illness" but as an "image" ("picture"), which often has several clinical manifestations, several potential etiological factors, and often several immune mechanisms.
The first group of inflammatory lesions of the glomerulus consists of proliferative glomerulonephritis:
- Mesangioproliferative (if predominantly mesangial cells proliferate);
- diffuse proliferative;
- extracapillary glomerulonephritis.
For these diseases is characterized primarily by nephritic syndrome: w "active" urinary sediment (erythrocytes, erythrocyte cylinders, leukocytes);
- proteinuria (usually not more than 3 g / day);
- renal failure, the severity of which depends on the prevalence of proliferation and necrosis, i.e. Active (acute) process.
Classification of primary glomerulonephritis
|
Proliferative forms |
Non-proliferative forms |
|
Acute diffuse proliferative glomerulonephritis Extracapillary (glomerulonephritis with "half-moon") - with immune deposits (anti-BMC, immunocomplex) and "low-immunity" Mesangioproliferative glomerulonephritis (MPH) IgA-nephropathy Mesangiocapillary glomerulonephritis |
Minimal changes Focal-segmental glomerulosclerosis Membranous glomerulonephritis |
The next group consists of non-proliferative glomerulonephritis, a disease in which the glomerular filter layers are affected, forming the main barrier primarily for proteins, namely, podocytes and the basal membrane:
- membranous nephropathy;
- the disease of minimal changes;
- focal segmental glomerulosclerosis.
These diseases are manifested mainly by the development of nephrotic syndrome - high (over 3 g / day) proteinuria leading to hypoalbuminemia, edema and hyperlipidemia.
Mesangiocapillary glomerulonephritis combines the features of the two groups described above. Morphologically it is characterized by the defeat of the basal membranes in combination with the proliferation of glomerulus cells (hence the other name for the disease is membrane-proliferative glomerulonephritis), and clinically by the combination of nephritic and nephrotic syndromes.
In Europe and the US, glomerulonephritis ranks third after diabetes mellitus and arterial hypertension among the causes of the final stage of renal failure requiring replacement therapy.
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