By Paul Sharpstone FRCP, J. A. P. Trafford FRCP (auth.)
The reason behind end-stage renal failure in one-third of sufferers handled via normal haemodialysis or kidney transplantation is a few number of glomerular illness. much less critical glomerular dis orders are extra universal and infrequently reason irrelevant conster country to the sufferers and, occasionally, to their medical professionals. related scientific positive aspects will be produced by means of pathological lesions starting from the trivial to the life-threatening, and renal biopsy is usually essential to determine the prognosis. even if, its common use up to now twenty years has enabled clinicopathological correlations to be made and the usual background of many 'glomerulopathies' to be validated, notwithstanding huge parts of uncer tainty stay. not like symptomatic measures, similar to the administration of uraemia or the nephrottc syndrome, using therapy in arresting the development of the glomerular lesion itself is controver sial and is predicated on anecdotal proof instead of managed trials. wisdom of the renal pathology will, at the very least, allow stipulations within which immunosuppressive treatment is suitable to be special from these that are benign or self-limiting. during this publication symptomatic administration of the scientific syn dromes is distinctive, yet type is firmly in response to renal histological appearances. The relevance of immunofluorescent microscopy, ultrathin part exam and electron micros replica to our knowing of pathogenesis is defined, in addition to the makes use of of those suggestions for morphological discrimination.
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1969). The most consistent clinical feature is proteinuria, which is often heavy enough to producl::. the nephrotic syndrome. Renal insufficiency is mild in many cases at the time of diagnosis, and the histological abnormality often appears disproportionately severe in comparison with the impairment of function. Hypertension may occur with advanced disease. The condition progresses slowly to terminal renal failure unless the primary cause can be treated successfully, in which case it usually Pathological Appearances and Clinical Associations 35 remains stationary rather than disappearing.
Schema of experimental nephrotoxic (antiglomerular basement membrane) nephritis. Human Glomerulonephritis Striking counterparts to the animal experiments suggest that some human types of glomerulonephritis may be immunologically mediated, although the evidence is not conclusive. Post-streptococcal Glomerulonephritis The latent period between infection with the streptococcus and the onset of nephritis resembles that between the injection and the onset of serum sickness nephritis. Immunofluorescence shows basement membrane deposits of IgG in the granular distribution characteristic of immune complex disease.
In chronic glomerulonephritis with serious impairment of kidney function, however, it is usual to see considerable sclerosis of the glomeruli. This scarring represents attempts at repair of repeated or continued insults, and it is this which is responsible for the permanent damage. 6. Investigations and Their Interpretation Laboratory investigations required in patients with glomerular disease are listed in Table 3. Technical details are outside the scope of this book, but some practical points in their performance and interpretation are discussed.