Glomerular lesions

Glomerulonephritis Glomerular lesions that are characterized by inflammation of the capillary loops of the glomerulus. These lesions are generally caused by immunologic, vascular, or other idiopathic diseases. Glomerulonephritis can lead to high blood pressure and loss of kidney function. 

This syndrome is characterized by proteinuria >3.5 g/day, hypoalbuminuria <3 g/dl, hyperlip-idaemia with an elevation of serum cholesterol, edema and oval fat bodies and fatty casts in the urinary sediment. A variety of disorders may produce nephrotic syndrome but, in the majority of cases, no cause is found. It is appropriate to define the selection of studies from the history and physical examination. Tests to order are antinuclear antibody, rheumatoid factor, cryoglobulins, serum complement, HBsAg VDRL serology (syphilis), protein electrophoresis of the serum and urine and HIV. If the cause is unclear a renal biopsy is done to define the glomerular lesion as treatment may on the underlying glomerular lesion. 

Hosokawa S, Tagaya O, Mikami T, et al. A new rat mutant with chronic conjugated hyperbilirubinemia and renal glomerular lesions. Lab Anim Sci 1992 42 27-34. 

Glomerular lesions, such as those found in diabetes and glomerular nephritis, are characterized by basement membrane thickening and an increase in collagen-like substances within the mesangial regions that ultimately lead to proteinuria. Protease inhibitors prevent thickening of the basement membrane and reduce proteinuria. 

Nagamatsu T, Hayashi K, Oka T, Suzuki Y (1999) Angiotensinll typel receptor antagonist suppresses proteinuria and glomerular lesions in experimental nephritis. Eur J Pharmacol 374 93-101... 

Lederer E, Truong L. Unusual glomerular lesion in a patient receiving long-term interferon alpha. Am J Kidney Dis 1992 20(5) 516-18. 

Renal complications that occur in relation to sulfonamide administration include crystalluria, tubular necrosis, interstitial nephritis, and glomerular lesions as part of a vasculitis syndrome. 

Nakatani, K., FI. Fuji , FI. Flasegawa, M.Terada, N. Arita, M. R. Ito, M. Ono, S.Takahashi, K. Saiga, S.Yoshimoto, et al 2004. Endothelial adhesion molecules in glomerular lesions association with their severity and diversity in lupus models. Kidney Int. 65 1290-1300. 

Justrabo E, Zanetta G, Martin L, Assem M, Mousson C, Maurice-Estepa L, Rifle G,Tanter Y. Irreversible glomerular lesions induced by crystal precipitation in a renal transplant after foscarnet therapy for cytomegalovirus infection. Eiistopathology 1999 34 365-369. 

Parenterally administered gold Histopathology of glomerular lesions Histopathology of interstitial lesions Pathogenesis Therapy and prognosis... 

HerveJP, LeguyP,CledesJ, Leroy JP. Nephrotic syndrome with minimal glomerular lesions during treatment with D-penIclllamlne. Nouv Press Med 1980 9 2847. 

Morphologic studies of radiation nephropathy have documented injury to blood vessels, glomeruh, tubular epithelium and interstitium. Recent ultrastructural studies indicate that glomerular endothelium is an early site of visible injury [236] with endothehal disruption and leukocyte adherence. Later, tubular degeneration and atrophy occur. The second pathophysiologic hypothesis holds vascular injury as the main initial event [237] which helps understand the hypertension occurring in radiation nephritis but does not account for the glomerular lesions. 

Pardo V, Aldana M, Colton RM, Fischl MA, Jaffe D, Moskowitz L, Hensley GT, Bourgoignie JJ. Glomerular lesions in the acquired immunodeficiency syndrome. Ann Intern Med 1984 101 429-434. 

Figure 1. Pathological aspect of Chinese herb nephropathy. Paucicellular interstitial fibrosis around atrophic tubules ( ). Fibrous thickening of the arteriolar walls (arrow). No glomerular lesion. H E staining, original magnification 300x. By courtesy of Dr. M. Depierreux.

Chavers BM, Bilous RW, EUis EN, Steffes MW, Mauer SM. Glomerular lesions and urinary albumin excretion in type I diabetes without overt proteinuria. 

Nakamura T, Obata J, Kimura H, Ohno S, Yoshida Y, Kawachi H, et al. Blocking angiotensin II ameliorates proteinuria and glomerular lesions in progressive mesangioproliferative glomerulonephritis. Kidney Int 1999 55 877-89. 

Proteinuria with or without a decline in the GFR is a hallmark sign of glomerular injury (see Chap. 47) Several different glomerular lesions may occur, mostly by immune mechanisms rather than direct toxicity. Although drug-induced glomerular disease is uncommon, a variety of agents have been implicated. 

Restriction of dietary gluten is effective in patients with celiac disease, but not in patients with no identifiable nephritogenic antigens. Phenytoin was evaluated because of its ability to reduce the amount of polymeric IgA in the circulation. Although phenytoin reduced serum IgA concentrations and frequency of macroscopic hematuria, the glomerular lesions deteriorated in some of the patients despite treatment. Removal of the tonsils, which produce IgAi and may contribute to IgA nephropathy, may reduce proteinuria and hematuria however, the beneficial effect of tonsillectomy on renal function longterm has not yet been substantiated. ... 

Patients with diabetes mellitus have a wide range of glomerular and tubular lesions. Glomerular lesions are more common. Increased glomerular filtration rates in diabetics correlate with increased glomerular and kidney size, and these changes are ascribed to increased levels of growth hormone. The most common... 

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