======Glomerular Disease======

=====Nephrotic Syndrome=====
  * 

=====Nephritic Syndrome=====
  * Low complement: post-infectious GN, SLE, MPGN
  * Normal complement: IgA, Anti-GM (Goodpasture's)

=====Epidemiology=====
  * Age < 15 years:
    * Nephrotic: MCD, FSGS
    * Nephritic: IgA, Hsp, post-infectious GN, MPGN, Alport
  * Age 15-40 years:
    * Nephrotic: 
    * Nephritic: 
  * Age > 40 years:
    * Nephrotic: 
    * Nephritic: 

=====Common causes=====
  * Hypocomplementemic
    * Primary renal: acute post-strep, MPGN
    * Systemic disease: SLE, IE, cryo, HCV
  * Normocomplementemics
  * Other infections (uncomm): M. leprae, P. facipraum, P. malariae, S. mansoni, Filatriasis

=====Lab abnormalities=====
  * UA: proteinuria, hematuria, casts
  * GFR intitially decreased
  * Streptococcal antibody profile
  * C3, C4 and/or CH50 depressed in 50%

=====Nephrotic Syndrome=====
  * Causes
    * Minimal change glomerulopathy
    * Membranous glomerulopathy: PLA2R, HLA-DQA1 secondary cause in 30%; often self limiting, treat with steroid + Cytoxans
    * FSGS: 5-12%, more common in AA; normal C4, C3, C2
      * Primary
      * Secondary
        * Familial/genetic
        * Viral (HIV/Parvovirus B19)
        * Drug-induced (heroin, IFN-alpha, lithium, pamidronate)
        * Mediated by responses
    * MPGN (also nephritic)
      * Primary
        * Type I: mesangiocapillary (more common)
        * Type II: dense deposit disease (5%)
        * Type III: mixed pattern
      * Secondary
    * IgA (Berger's)
      * common in Asia (>30%), Europe (20-25%), US (10%)
      * overproduction of IgA1
    * Fibrillary GN
    * Diabetic glomerulopathy
    * Amyloidosis
    * Light chain deposition disease
  * Approach
    * History/physical
    * Lab: CrCl, SPEP/UPEP, lipids, cholesterol, complements, ANA, cryoglobulin, hepatitis serologies
    * Renal biopsy: when no clear cause evident, or possible cause with atypical course

=====Rapidly Progressive Glomerulonephritis=====
  * Clinical term
  * Often associated with crescentic
  * Immunofluorescence pattern:
    * Antibody mediated
      * Goodpasture's (anti-GBM with lung involvement)
      * anti-GBM without lung involvement
    * Pauci-immune
      * Microscopic
      * Wegner's (ANCA, mostly PR3)
      *
    * Immune-complex mediated

=====HUS/TTP=====
  * Features
    * Thrombocytopenia
    * MAHA
    * Acute renal failure
    * Neurological symptoms/signs
    * Fever
  * Adult
    * Idiopathic/ADAMSTS13 deficiency
    * Hereditary defector of plasma factor H
    * Drugs

=====SLE=====
  * Classes
     * I. No abnormalities: no treatment (guided by extrarenal symptoms)
     * II. Mesangial lupus nephritis: corticosteroids
     * III. Focal segmental lupus nephritis (<50%): corticosteroids + immunosupressive agents
     * IV. Diffuse proliferative lupus nephritis (>50%): cyclophosphamide pulses, methylprednisone pulses, oral prednisone, azathioprine
     * V. Membranous lupus nephritis: corticosteroids with/without immunosuppresive agents
     * VI. Advanced sclerosing lupus nephritis: dialysis, transplantation