What glomerular disorders are commonly seen in SCN

What glomerular disorders are commonly seen in SCN?

• Secondary focal segmental glomerulosclerosis (FSGS) and its variants are major glomerular lesions observed in SCD. Both collapsing and noncollapsing patterns of FSGS have been described. The development of FSGS is likely adaptive to the initial glomerular hyperfiltration followed by repeated episodes of ischemia and reperfusion injuries. Glomerular hypertrophy was found to be greater in HbS patients than in idiopathic FSGS. Medullary fibrosis is prominent, suggesting that SCD-associated FSGS mainly affects the juxtamedullary nephrons supplied by the vasa recta.

• Membranoproliferative glomerulonephropathy and thrombotic microangiopathy may also occur, but at a lower frequency than FSGS. Membranoproliferative glomerulonephritis (MPGN) with mesangial expansion and basement membrane duplication may be seen either as an isolated finding or in association with FSGS. It has been suggested that this rare form of MPGN is caused by fragmented red blood cells lodged in isolated capillary loops and phagocytosed by mesangial cells, stimulating the expansion of the mesangium and new basement membrane deposition. Although MPGN was initially attributed to immune complex injury, subsequent studies demonstrated that MPGN commonly occurred without immune complex deposits. In essence, the absence of immune complexes and electron-dense deposits differentiates SCD-associated MPGN from other forms of MPGN that are associated with lymphoproliferative or autoimmune disorders, chronic infections, or dysregulation of the complement system.

• Although rare with modern screening for blood borne pathogens, HIV nephropathy and hepatitis-associated glomerulonephropathies may be possible.

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