NEPHROTIC SYNDROME
𖣔 Caused
- Masive Proteinuria
- hyperlipidemia
- severe edema (anasarca)

𖣔 Cause
𖦹 Primary
• Membranous nephropathy
• Manimal changes disease
• focal segmental glomerulosclerosis
• Membranoproliferative glomerulonephritis

𖦹 Secondary
- diabetic nephropathy
- Immunologic disease


•°•°•°•°•°•°•°•°•°•°•°•°•°•°•°•°•°•°•°•°

MINIMAL CHANGE DISEASES
( Lipoid nephrosis )

✫ Definition
Idiopathic glomerular disease that causes nephrotic syndrome

Most common type of nephrotic syndrome in children


✫ Gross description
Enlarged, waxy yellow cortex due to lipid accumulation in proximal tubules

✫Microscopic description
- Glomerulus normal
- No tubular atrophy
- No interstitial scarring
- Lipid droplets deposetion in tubules
By Periodic acid - methenamin sliver stain (Jones stain)
- BM & Mesangial matrix ➪ black
- epithelium cell & mesangial cell ➪ grey pink


✫Electron microscopy description
- foot process of podocyte effacement
- Normal fenestrated
- Normal BM in thickness

✫Immunofluorescence
Negative

..

#MICROSCOPIC

#Diagnosis 👉🏻 Minimal change disease

#The_blue_arrows
Fat droplets in tubules

#The_black_arrows
lipid laden macrophages in the interstitium

#ELECTRON_MICROSCOP

#Diagnosis 👉🏻 Minimal change disease
OR
Focal segmental glomerulonephritis

#The_black_arrow
Foot processes effacement

#The_blue_arrow
BM

#The_red_arrow
Fenestrated endothelium

#The_yellow_arrow
Electron dense RBCs

#MICROSCOPIC

#Diagnosis 👉🏻 Minimal change disease


#The_black_arrow
Normal glomerulus

#Type_of_stain
H&E stain

#MICROSCOPIC

#Diagnosis 👉🏻 Minimal change disease

#The_yellow_arrows
mesangial cell

#The_red_arrows
BM

#The_black_arrow
Podocyte

#The_blue_arrows
epithelium cell

#Type_of_stain
Periodic acid-methenamin sliver stain (Jones stain)

#صورة_اكثر_وضوحاً
#MICROSCOPIC

#Diagnosis 👉🏻 Minimal change disease

#The_asterisks
Capillary loops are mildly ectatic

#The_black_arrows
podocyte

#The_red_arrows
mesangial cells

#The_blue_arrows
Fat droplets

FOCALE SEGMENTAL GLOMERULOSCLEROSIS

Causes 10% of nephrotic syndrome in children , 20% in adults

✫Microscopic description
- Increased mesangial cells (proliferative) , and mesangial matrix
- Hyaline deposition (hyalinosis)
- collagen deposition show by trichrome stain
- obliterated capillary lumina
- foamy (lipid-laden) macrophages
- Focal and segmental
sclerosis that appear to adhere to Bowman capsule
- tubular atrophy with interstitial fibrosis

و يظهر ايضاً morphologic variant يلي يدعى collapsing glomerulopathy والذي يتميز بـ collaps of glomerular tuft
والذي يعتبر more severe manifestation of FSGS

✫Immunofluorescence
Positive

..

#MICROSCOPIC

#Diagnosis 👉🏻 Focal segmental glomerulosclerosis
(Collapsing)

#The_yellow_arrows
mesangial cell

#The_black_area
sclerosis adhere to Bowman capsule

#The_blue_arrows
Podocyte

#The_black_arrow
Sclerosis

#Type_of_stain
Periodic acid schiff (PAS)

#MICROSCOPIC

#Diagnosis 👉🏻 Focal segmental glomerulosclerosis
(Collapsing)


#The_black_arrow
Sclerosis

#Type_of_stain
Jones stain

#MICROSCOPIC

#Diagnosis 👉🏻 Focal segmental glomerulosclerosis


#The_yellow_arrows
mesangial cell

#The_black_arrow
Sclerosis

#MICROSCOPIC

#Diagnosis 👉🏻 Focal segmental glomerulosclerosis


#The_black_arrow
Sclerosis

#MICROSCOPIC

#Diagnosis 👉🏻 Focal segmental glomerulosclerosis


#The_black_arrow
Collagen deposition

MEMBRANOUS NEPHROPATHY
is a form of chronic immune
complex glomerulonephritis induced by antibodies reacting
in situ to glomerular antigens.

And the most common causes of nephrotic syndrome in adults

✫Microscopic description
- Cellularity is not increased
- Thickening in the capillary BM
- Spike formation appearance on Jones silver stain and electron microscopy

✫Electron microscopy description
- Electron dense immune deposits (draker area) within the thickened capillary BM
- effacement of foot processes
- Spikes: lighter area represents the intervening matrix of basement membrane between the deposits

#MICROSCOPIC

#Diagnosis 👉🏻 Membranous nephropathy


#The_blue_arrow
capillary loops are diffusely thickened and prominent

#ELECTRON_MICROSCOPY

#Diagnosis 👉🏻 Membranous nephropathy



#The_blue_arrow
spikes

#The_red_arrow
electron-dense immune deposits 

#MICROSCOPIC

#Diagnosis 👉🏻 Membranous nephropathy

#The_blue_areas
Spikes

#Type_of_stain
Jones silver stain

MEMBRANPROLIFERATIVE GLOMERULONEPHRITIS
is a type of glomerular injury caused by immune-complex deposition on the luminal (subendothelial) surfaces of capillary walls
The causes may
- primary (idiopathic)
- Secondary to autoimmune diseases, infections, and malignancies

✫Microscopic description
- glomeruli are large
- Thickening in the capillary BM
- Cellularity is increased due to Mesangial proliferation
- Increased mesangial matrix
- infiltrating leukocytes
- glomerular capillary wall shaw a forming double contour / tram track appearance by Jones silver stain

#MICROSCOPIC

#Diagnosis 👉🏻 Membranoproliferative Glomerulonephritis


#The_black_arrow
hypercellularity

#MICROSCOPIC

#Diagnosis 👉🏻 Membranoproliferative Glomerulonephritis

#The_black_arrow
Double contour

#Type_of_stain
Jones silver stain

BENIGN NEPHROSCLEROSIS
Also called hypertensive nephrosclerosis

The causes
- primary ➪idiopathic, stress , ischemia
- Secondary ➪ inflammation in the kidney (pylonephritis) , Cushing syndrome

وكلها بتعمل hypertension مما يسبب
Sclerosis of renal arterioles and small arteries, particularly afferent arterioles


✫ Gross description
- Ischemia atrophy (greenish in color)
- Mildly shrunken kidneys (reduced in size)
- cortical surface resembles leather
- focal loss of renal parenchyma that gives the surface of the kidney the characteristics granular appearance
- cut surface shows irregular atrophy of cortex


✫Microscopic description
- hyaline arteriosclerosis that caused narrow and Thickening in the arterioles
- Tubular atrophy
- thyroidisation
- chronic inflammatory cells