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Kidney involvement in systemic disease

  1. Kidney in diabetes
    In diabetes diffuse glomerular lesions are the most common
    The morphological changes in Glomeruli is diabetic glomerulosclerosis include:
    1. Capillary basement membrane thickening earliest
      1. Various exudative lesions such as capsular hyaline drops or 'fibrin caps' may be present
      2. Capsular drop: is an eosinophilic thickening of parietal layer of Bowman's capsule and bulges into glomerular space
    2. Diffuse glomerular lesions are the most common
    3. Nodular glomerulo sclerosis
      Also called Kimmelstiel Wilson disease. Are virtually pathognomic of diabetes (most characterstic)

Extra Edge Focal sclerosis is not a characteristic feature of Diabetic Nephropathy.

  1. Kidney in HIV
    The most characteristic glomerulopathy in HIV is focal segmental glomerulosclerosis (FSGS) (LQ 2012) which typically reveals collapse of the glomerular capillary tuft called collapsing glomerulopathy. (LQ 2012)
  2. Renal involvement in HT
    1. Benign nephrosclerosis (Hyaline arteriosclerosis)
    2. Malignant Hypertension (Fibrinoid necrosis)
  3. Renal involvement in SLE
Table: Classification for Lupus Nephritis (Ref. Hari. 18th ed., pg - 2341, Table 283-3)
Class I Minimal mesangial Normal histology with mesangial deposits
Class II Mesangial proliferation Mesangial hypercellularity with expansion of the mesangial matrix
Class III Focal nephritis Focal endocapillary ± extracapillary proliferation with focal subendothelial immune deposits and mild mesangial expansion
Class IV Diffuse nephritis Diffuse endocapillary ± extracapillary proliferation with diffuse subendothelial immune deposits and mesangial alterations (Diffuse wire loop deposits)
Class V Membranous nephritis Thickened basement membranes with diffuse subepithelial immune deposits; may occur with Class III or IV lesions and is sometimes called mixed membranous and proliferative nephritis
Class VI Sclerotic nephritis Global sclerosis of nearly all glomerular capillaries


Extra Edge In SLE, wire loop deposits is seen in diffuse nephritis

Differential diagnosis of Glomerular Disease based on complement levels
Low complement levels Normal complement levels
1. Crescentic glomerulonephritis
2. Membranoproliferative glomerulonephritis
3. Lupus nephritis
4. Cryoglobulinemia
5. Bacterial endocarditis
6. Post streptococcal
1. Anti GBM disease: Good posture's syndrome
2. Wegener’s granulomatoses
3. Microscopic polyarteritis nodosa
4. Immune complex mediated
5. IgA Nephropathy
6. Henoch Schönlein purpura


Extra Edge
Glomerulonephritis without proliferative changes
  1. Minimal change Disease
  2. Membranous Glomerulonephritis
  3. Diabetic Nephropathy
  4. Amyloidosis
  5. Focal segmental Glomerulosclerosis
Glomerulonephritis with proliferative changes
  1. IgA
  2. MPGN
Important Points

Table:20-11, Renal Involvement in Nonrenal neoplasms (Ref. Hari. 18th ed., Pg - 1005)

  1. Direct tumor invasion of renal parenchyma
    1. Ureters (obstruction)
    2. Artery (renovascular hypertension)
  2. Hypercalcemia
  3. Hyperuricemia
  4. Amyloidosis
  5. Excretion of abnormal proteins (multiple myeloma)
  6. Glomerulopathy
    1. Immune complex glomerulonephritis (carcinomas)
    2. Minimal change disease (Hodgkin disease)
    3. Membranoproliferative glomerulonephritis (leukemias and lymphomas)

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