Overview of the pathogenesis and causes of glomerulonephritis in children
- Patrick Niaudet, MD
Patrick Niaudet, MD
- Section Editor — Pediatric Nephrology
- Professor of Pediatrics
- Hôpital Necker-Enfants Malades, Paris, France
Glomerulonephritis (GN) generally presents as a constellation of findings that include hematuria, proteinuria, edema, and often hypertension. GN is caused by a number of disorders that are all characterized by glomerular injury accompanied by inflammation. In some cases, GN may progress to renal failure.
The pathogenesis and etiology of glomerulonephritis in children will be reviewed here. The approach to evaluating a child with glomerulonephritis is discussed separately. (See "Evaluation of a child with glomerular disease".)
Although the pathogenesis is not fully understood, current evidence suggests that most cases of glomerulonephritis (GN) are due to an immunologic response to a variety of different etiologic agents. The immunologic response, in turn, activates a number of biological processes (eg, complement activation, leukocyte recruitment, and release of growth factors and cytokines) that result in glomerular inflammation and injury [1,2]. GN may be isolated to the kidney (primary glomerulonephritis) or be a component of a systemic disorder (secondary glomerulonephritis) (table 1).
The immunologic mechanisms involved in the pathogenesis of GN are briefly reviewed here and are discussed in greater detail separately. (See "Mechanisms of immune injury of the glomerulus".)
Immunologic damage — Humoral (also referred to T helper cell 2-regulated) immune response to a variety of inciting agents results in immunoglobulin deposition and complement activation within the glomeruli. In most of these disorders, immune complex deposition is an active process caused by in situ binding of antibodies to antigens localized within the glomeruli. The antigens may be structural glomeruli components, such as the Goodpasture antigen in the non-collagenous domain of the alpha-3 chain of type IV collagen in the glomerular basement membrane (GBM) .
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- Immunologic damage
- Secondary processes
- ETIOLOGIC CLASSIFICATION
- Clinical presentation
- - Acute GN
- - Rapidly progressive GN
- - Recurrent macroscopic hematuria
- - Chronic GN
- - Light microscopy
- - Immunofluorescence microscopy
- - Electron microscopy
- SPECIFIC DISORDERS
- Primary GN
- Secondary GN
- INFORMATION FOR PATIENTS
- SUMMARY AND RECOMMENDATIONS