Atlas of Renal Pathology IIAJKD Atlas of Renal Pathology: Postinfectious Glomerulonephritis
Section snippets
Clinical and Pathologic Features
Postinfectious glomerulonephritis (GN) presents as acute nephritic syndrome with low complement C3 in serum, commonly following streptococcal throat or skin infection. Other infections may also give rise to postinfectious GN. Postinfectious GN most commonly occurs in children or young adults. The prognosis is excellent in children when the underlying infection resolves. Older adults, often diabetic or immunocompromised, may also develop postinfectious GN, more often from visceral sites of
Etiology/Pathogenesis
Antigens of infectious agents activate the alternative complement pathway. Immune complexes may be circulating, or antigens can bind within the glomerulus with antibody and complement activation occurring in situ. Streptococcal pyrogenic exotoxin B has been proposed as a causative antigen in postinfectious GN following group A streptococcal infection.
Differential Diagnosis
Subepithelial humps are highly suggestive of postinfectious GN, but may also be seen in C3 GN. Other immune complex diseases may have endocapillary hypercellularity shown by light microscopy, but lack frequent neutrophils. Some processes have disease-specific immunofluorescence findings (eg, lupus nephritis), and do not show dominant C3 or frequent hump-type deposits.
Key Diagnostic Features
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Global endocapillary hypercellularity, with frequent neutrophils
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Dominant irregular capillary wall and mesangial C3, often with immunoglobulin G, and uncommonly immunoglobulin A
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Subepithelial hump-like deposits
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