In black patients : – Focal segmental glomerulosclerosis (57 percent) – Membranous nephropathy (24 percent) – Minimal change disease (14 percent) – Membranoproliferative glomerulonephritis, IgA nephropathy, and immunotactoid nephropathy were each present in 1 to 2 percent.
Positive family history Thin basement membrane nephropathy Hereditary nephritis (Alport syndrome) Focal segmental glomerulosclerosis are examples:
LABORATORY TESTING IN PATIENTS WITH SUSPECTED GLOMERULAR DISEASE serum creatinine serum albumin complete blood count Estimation of protein excretion in patients with proteinuria serologic testing for disorders that cause glomerular disease measurement of serum complement levels
membranous nephropathy The value of hepatitis B virus Hepatitis C virus (HCV) infection Congenital and secondary syphilis HIV infection (FSGS)
Chronic bacterial – Endocarditis – Shunt nephritis – Abscesses Fungal Parasitic infections can cause
SUMMARY AND RECOMMENDATIONS There are many causes of glomerular disease, the characteristics of the urine sediment, The degree of proteinuria Patient’s age often
Two different urinary patterns are seen: – Nephrotic – Nephritic.
The nephrotic pattern = proteinuria > 3.5 g/day Lipiduria
The nephritic Red cells White blood cells Red cell or mixed cellular casts Acanthocytes Some patients have the concurrent presence of two glomerular diseases,
Approaching a patient Urinalysis Estimated glomerular filtration rate Patient age help to identify Race Family history Renal biopsy
Standard laboratory testing Serum creatinine Serum albumin Protein excretion in patients with proteinuria Serologic testing for disorders that cause glomerular disease
Serologic tests – Lupus – Amyloidosis – Hepatitis B (HBV) – Hepatitis C (HCV) – HIV infection – ANA – Anti-dsDNA – C3 – C4
Primary amyloidosis and light chain deposition disease – Serum and urine immunofixation – Serum free light chain ratio analysis
Glomerulonephritis Nephritic urine RBCs, RBC casts Low – mod proteinuria Nephrotic urine No casts, few RBCs Heavy proteinuria Diabetes Amyloid Membranous Nephropathy FSGS Minimal Change Disease Sometimes MPGN C3, C4 LowNormal Postinfectious Lupus nephritis MPGN (often Hep C) progress fast progress slow ANCA (+)ANCA (-) Vasculitis Wegener’s MPA Churg-Strauss IgA nepropathy Anti-GBM/Goodpasture’s