Glomerular Disease

Nephrotic Syndrome

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:

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

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

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