glomerular disease

Normal glomerulus, light microscopy in trichrome stain. Blue - glomerular truft and blue BM of cap wall . ure1
Normal glomerulus - EM; L = lumen, e - endothelial cell body; M=mesengial cell; F= foot processes; p = podocyte; U = urinary space
normal glomeruli - Glomerular filter EM, Capillary Lumen, Urinary space, Fenestration; Endothelial cell; BM of laminar rara and lamina densa; slite diaphragm, Foot processes
Minimal change disease - Normal glomerulus in LM and IF
Minimal change glomerulopathy - light micrograph shows no abnormality
Minimal change disease - Foot process fusion in EM. Loss of GBM negative charge causes selective loss of albumins, but not globulins
Minimal change GN - podocyte has extensive effacement of foot processes
Membranous glomerulopathy - diffuse capillary and GBM thickening
Membranous glomerulopathy - silver stain - granularity shows immune complexes
Membranous glomerulopathy - granular subepithelial IgG+
Membranous glomerulopathy 3 - granular subepithelial IgG+
Membranous glomerulopathy - accumulation of dense immune complex IgG on subepithelial side of BM
Membranous glomerulopathy 2 - Diffuse thickening of capillary wall, no hypecellularity
Membranous glomerulopathy 4. MCC adut nephrotic s/d , a/w HBV
Focal segmental glomerulosclerosis - only part of glomeruli involved. a/s HIV and blacks
Focal segmental glomerulosclerosis - trichome stain - mesangial matrix and cell increased

- high recurrence rate (50% even after transplant)
- can recur immediately after kidney transplantation (indicates circulating factor responsible for disease)
Focal segmental glomerulosclerosis - IF - IgM deposition in areas of sclerosis
Focal segmental glomerulosclerosis - mesangial sclerosis, lipid vacuoles
Focal segmental glomerulosclerosis - only part of glomeruli involved 2
Focal segmental glomerulosclerosis - only part of glomeruli involved
IgA nephropathy (Berger's d/s) - mesangial proliferation and hypercellularity
IgA nephropathy (berger's d/s, a/w HSP) - granular IgA based IC deposits in mesangium
IgA nephropathy (Berger's d/s) - mesangial cell dense deposits (on subendothelial side)
Poststreptococcal glomerulonephritis - VERY cellular glomerulus. "lumpy-bumpy appearance"
Poststreptococcal glomerulonephritis - granular appearance d/t IgG, IgM and C3 depositions in GBM and mesangium
Poststrepglomerulonephritis -subepithelial coarsely granular lumpy bumpy
Poststrep glomerulonephritis - endothelial cell with lumps, bumps in subepithelial
Poststreptococcal glomerulonephritis - large subepith granules
Poststreptococcal glomerulonephritis - seen in children 2-3 weeks after strep
Membranoproliferative glomerulonephritis - lobular pattern and hypercellular, cannot see open capillary loops

increased lobulation of glomerulus
Membranoproliferative glomerulonephritis - PAS shows BM duplication (tram track) and mesangial hypercellularity
Membranoproliferative glomerulonephritis - granular IgG deposition in mesangium and subendothelium

increased lobulation of glomerulus
Membranoproliferative glomerulonephritis type `- subendothelial layer - cells try to cover it to make tram tracks

BM duplication and subendothelial electron-dense deposits (blue arrows)
Membranoproliferative glomerulonephritis - type II - very dense, large crescent shape of deposit

Band-like subendothelial deposition of C3
Membranoproliferative glomerulonephritis - uncontrolled activation of complement
Cryoglobulinemia (cryoglobulin because Ab to Ab to Ag) - seen in Membranoproliferative glomerulonephritis
Rapidly Progressive (crescent) GN - hypercellular glomerulus, crescents, fibrin deposition and collapse of glom tuft

Severe injury causes glomerular tuft fragmentation and and a break in capsule (double arrow)
Rapidly Progressive (crescent) - Proliferation of parietal epithelial cells lining Bowman's Capsule and mononuclear cell infiltrate. There are prominent fibrin strands btwn the cell layers in the crescents.
Amyloidosis - apple green firengence on congo red stain with polarized light
Amyloidosis - apple green
Amyloidosis - fibrils deposited -> mesangial expansion
Amyloidosis 2
Amyloidosis - Congo red stain of amyloid
Amyloidosis - not as PAS pos as diabetic
Amyloidosis - expansion of mesangium by amyloid fibrils that are 8-10nm in diameter. Individual fibrils within each plane interlace to form groups of fibers in parallel.
Amyloidosis - amyloid deposition not as PAS positive as diabetoc
Amyloidosis - Amorphous acellular meterial expands mesangial areas and obstructs glomerular capillaries.
Diabetic nephropathy - Pseudo-linear peripheral IgG and Albumin deposits and nodular mesangial IgM + C3 deposits
Diabetic nephropathy - advanced KW disease (nodular expansion of PAS positive, mesangial matrix)
Diabetic nephropathy - IgG and IgM and albumin sticking in blood vessels

Deposits of amorphous material in vessels (arteriosclerosis)
Diabetic nephropathy - Kimmselstiel-Wilson nodules (nodular expansion of PAS positive, mesangial matrix)
Diabetic nephropathy - nodular deposition of acellular material
Diabetic nephropathy - thickened BM,
matrix-expanded mesangium
Diabetic nephropathy - thickened capillary loop
Diabetic nephropathy

1. Capillary Basement Membrane Thickening
2. Diffuse Mesangial Sclerosis (PAS+ staining)
3. Nodular Glomerulosclerosis
4. Hyalinizing Arteriosclerosis (worst in the hilar vessels)
Dysmorphic RBC - nephritic syndrome
Goodpasture's syndrome (lung involvement)
Lupus nephropathy - granular mesangial IgG, IgM, and complement deposits

corner looks like its looped for lupus
Lupus nephropathy - mesangial proliferation characteristic of all classes of lupus nephritis.