The given clinical scenario and histopathology image are suggestive of nephritic syndrome, occurring as a consequence of post-streptococcal glomerulonephritis (PSGN).

The PSGN patient presents with hematuria, red cell casts in the urine, azotemia, oliguria, hypertension, mild to moderate proteinuria, and edema (features of nephritic syndrome)

The classic histopathology picture is of enlarged, hypercellular glomeruli with influx of leucocytes (endocapillary proliferation).

Related Pearl: Types of Rapidly Progressive Glomerulonephritis

Type I (Anti-GBM Antibody)

Renal limited

Goodpasture syndrome

Immunofluorescence:

Linear GBM deposits of IgG and C3

Type II (Immune Complex)

Idiopathic

Post-streptococcal glomerulonephritis

Membranoproliferative glomerulonephritis

Crescentic glomerulonephritis

Lupus nephritis

Henoch–Schönlein purpura

IgA nephropathy

Others: Cryoglobulinemia, Bacterial endocarditis, sepsis, acute pancreatitis/advanced liver disease

Immunofluorescence: Granular pattern of staining

Type III (Pauci-Immune)

ANCA-associated

Idiopathic

Granulomatosis with polyangiitis (formerly Wegener granulomatosis)

Microscopic polyangiitis

Immunofluorescence: No immunoglobulin or complement deposits

Image: Crescentic glomerulonephritis (PAS stain) with the crescent-shaped mass of proliferating parietal epithelial cells and leukocytes internal to Bowman capsule.

Related Pearl: Glomerular Pathology in Renal Diseases

Disease	Light microscopy	Fluorescence microscopy	Electron microscopy
Nephritic syndrome:
Postinfectious glomerulo-nephritis	Diffuse endocapillary proliferation; leukocytic infiltration	Granular IgG and C3 in glomerular basement membrane and mesangium, Granular IgA in some cases	Subepithelial humps Subendothelial deposits in early disease stages
Goodpasture syndrome	Extracapillary proliferation with crescents; necrosis	Linear IgG and C3; fibrin in crescents	Linear deposits along the basement membrane. Disruptions in GBM
IgA nephropathy (Berger disease)	Focal mesangial proliferative glomerulo-nephritis; mesangial widening	IgA ± IgG, IgM, and C3 in mesangium	Mesangial and paramesangial dense deposits
Alport syndrome	Normal	Negative	Basket-weave appearance of GBM
Nephrotic syndrome:
Membranous nephropathy	Diffuse capillary wall thickening	Granular IgG and C3; diffuse	Subepithelial deposits (epimembranous spikes), effacement of podocyte
Minimal change disease	Normal; lipid in tubules	Negative	No deposits. Effacement of podocyte
Focal segmental glomerulo-sclerosis (FSGS)	Glomerular hyalinosis and sclerosis	Occasional C3 and IgM deposits in the sclerotic areas and the mesangium.	No deposits. Effacement of podocyte Epithelial denudation.
Nephrito-nephrotic syndrome:
Membrano-proliferative glomerulo-nephritis (MPGN) type I	Mesangial proliferative pattern of proliferation; GBM thickening; splitting	C3, C1q, C4 deposits IgG deposits	Subendothelial deposits
Dense-deposit disease (MPGN type II)	Mesangial proliferative pattern of proliferation; GBM thickening; splitting	C3 deposits; No C1q and C4 deposits No IgG deposits	Intramembranous Dense deposits
Fibrillary glomerulo-nephritis	Membrano-proliferative or mesangio-proliferative patterns	IgG4 and C3	Fibrillar deposits in the mesangium and capillary walls

Note:

Anionic antigens form subendothelial deposits.
Cationic antigens form subepithelial deposits.
Neutral antigens form mesangial deposits.

#Clinical Mini Test I

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