Patterns of glomerular injury and their clinical expression

Glomerular response to injury

Renal injury can be caused by immune, infectious, toxic, metabolic, genetic and hemodynamic factors. The glomerular response to injury results in morphological and functional changes which are reflected by the clinical symptoms. Glomerular changes observed in antibody-mediated forms of glomerulonephritis (GN) and the associated clinical symptoms are exemplary to most cases of glomerular injury (Nephrology 3:633-637, 1997) and thus offer a rational way to understand the pathogenesis, classification and clinical implication of all forms of glomerulonephritis.

The morphological and clinical expression of antibody-mediated glomerular injury is largely dependent on the glomerular compartment where the antibodies accumulate (Kidney Int 34:333-345, 1988). In this respect, three compartments can be recognized:

1. the subendothelial and glomerular basement membrane (GBM) area;
2. the subepithelial compartment; and
3. the mesangium.