Diabetic glomerulosclerosis is characterized by all EXCEPT
(Fibrin clot) (677-78-Harsh. Mohan 6th ,1141- Robbiins - Basis of disease 8th)DIABETIC NEPHROPATHYFour types renal lesions1. Diabetic glomerulosclerosis2. Vascular lesions - (Atheroma, Hyaline arteriolosclerosis)**3. Diabetic pyelonephritis (Papillary necrosis (necrotizingpapillitis)**4. Tubular lesions (Armanni- Ebstein lesions)* Earliest manifestation of diabetic nephropathy is microalbuminuria (> 30mg/day, but < 300mg/day)DIABETIC GLOMERULOSCLEROSIS(i) Diffuse glomerulo sclerosis - Most common lesions** thickening of the GBM and diffuse increase in mesangial matrix with mild proliferation of mesangial cells* Capsular hyaline drop is an eosinophilic hyaline thickening of the parietal layer of Bowman's capsule and bulges into the glomerular space* Fibrin cap* is a homogenous, brightly eosinophilic material appearing on the wall of a peripheral capillary of lobule(ii) Nodular glomerulo sclerosis (Kimmelstiel - Wilson (K. W) lesions** or intercapillaiy glomerulosclerosis) - specific for type I-DMThe nodules are PAS positive and contain lipid and fibrinAs a result of glomerular and arteriolar involvement renal ischaemia occurs leading to tubular atrophy and interstitial fibrosis and grossly small contracted kidney **Important Points* Nephrocalcinosis is seen in - Hyperparathyroidism, Hypercalcemia, Hyperphosphatemia, RTA*. Hyper vitaminosis D, Excessive bone destruction. In metastatic malignancy, Hyperthyroidism. Milk-alkali syndrome and Sarcoidosis Medullary sponge kidney* (Papillary- nephrocalcinosis)* Low and fixed specific gravity of urine is seen in CRF* Most of the infectious causes lead to membranous GN like Hepatitis B & C,syphilis, malaria, leprosy*, filariasis & schistosomiasis, carcinoma of lung* and melanomaGeneChromosomeProteinLocationDiseaseNPHS-119q 13Nephrin*Slipt diaphragmNephrotic syndrome of finish type**NPH-2**1 q25-31PodocinSlipt diaphragmSteroid resistant** nephritic syndrome* Fibrinogen level is increased in Nephrotic syndrome due to increased hepatic synthesis of fibrinogen* The classic and most common HIV associated glomerulopathy is an aggressive form of focal segmental glomerulosclerosis, an entity that is termed HIV associated nephropathy (It was earlier called collapsing glomerulopathy)** shows degeneration of visceral epithelium*** Focal segmental GN - seen in SLE, H.S purpura, SABE, wegner's granulomatosis, PAN, Goodpasteur's syndrome* Low C3 complex GN - Post infections GN, lupus nephritis cryoglobulinemia, Bacterial endocarditis shunt nephritis, membrano proliferative GN, Cresenteric GN, Idiopathic proliferative GN* Most specific and sensitive marker of ANCA is seen in idiopathic cresenteric GN*** Hereditary Nepritls occursin - Alport's syndrome, Fabry's disease, Nail patella syndrome
Diffuse glomerulosclerosis
Fibrin cap
Fibrin clot
Kimmelstiel-Wilson lesions
Kidney