Glomerular disease

doi:10.1093/med/9780199229567.003.0003

Oxford Desk Reference: Nephrology (1 edn)

Jonathan Barratt (ed.) et al.

https://doi.org/10.1093/med/9780199229567.001.0001

Published online:

01 October 2011

Published in print:

01 November 2008

Online ISBN:

9780191725739

Print ISBN:

9780199229567

- Copyright Page
  - Notes
  - Notes
- Preface
  - Notes
  - Notes
- Acknowledgements
  - Notes
  - Notes
- Abbreviations
  - Notes
  - Notes
- Contributors
  - Notes
  - Notes
1 Assessment of renal disease
- Notes
- Notes
2 Fluid and electrolyte disorders
- Notes
- Notes
- Chapter contents Chapter contents
- Proteinuria and/or hematuria Proteinuria and/or hematuria
  - General principles General principles
  - Initial evaluation Initial evaluation
    - History History
    - Examination Examination
    - Investigations Investigations
  - Interpreting proteinuria values Interpreting proteinuria values
    - Normal Normal
    - Nephrotic-range proteinuria Nephrotic-range proteinuria
    - Non-nephrotic proteinuria Non-nephrotic proteinuria
    - Microalbuminuria Microalbuminuria
  - Interpreting evidence of hematuria Interpreting evidence of hematuria
  - Asymptomatic proteinuria (Fig. ) Asymptomatic proteinuria (Fig. )
    - ‘Functional’ proteinuria ‘Functional’ proteinuria
    - Overflow proteinuria Overflow proteinuria
    - Tubular proteinuria Tubular proteinuria
    - Orthostatic proteinuria Orthostatic proteinuria
    - Persistent non-nephrotic proteinuria Persistent non-nephrotic proteinuria
      - Role of renal biopsy Role of renal biopsy
    - Asymptomatic proteinuria with hematuria Asymptomatic proteinuria with hematuria
    - Proteinuria with hematuria and with multisystem disease Proteinuria with hematuria and with multisystem disease
  - Isolated microscopic (nonvisible) hematuria (Fig. ) Isolated microscopic (nonvisible) hematuria (Fig. )
    - Urological evaluation Urological evaluation
    - Role of renal biopsy Role of renal biopsy
  - Macroscopic (visible) hematuria Macroscopic (visible) hematuria
  - Further reading Further reading
  - See also See also
- Nephrotic syndrome Nephrotic syndrome
  - Etiology Etiology
  - Clinical features, complications, and pathogenesis Clinical features, complications, and pathogenesis
    - Presenting features Presenting features
    - Proteinuria Proteinuria
    - Hypoalbuminemia Hypoalbuminemia
    - Edema Edema
      - Underfill model Underfill model
      - Overfill model Overfill model
    - Hyperlipidemia Hyperlipidemia
    - Hypercoagulability and thrombosis Hypercoagulability and thrombosis
    - Infection Infection
    - Metabolic abnormalities Metabolic abnormalities
    - Protein wasting/negative nitrogen balance Protein wasting/negative nitrogen balance
    - Renal dysfunction Renal dysfunction
      - Chronic kidney disease (CKD) Chronic kidney disease (CKD)
      - Tubular dysfunction Tubular dysfunction
  - Management Management
    - Edema Edema
    - Proteinuria Proteinuria
      - RAS inhibition RAS inhibition
      - Low protein diet Low protein diet
      - Other pharmacological approaches Other pharmacological approaches
      - Nephrectomy Nephrectomy
    - Hyperlipidemia Hyperlipidemia
    - Hypercoagulability Hypercoagulability
      - Prophylactic anticoagulation Prophylactic anticoagulation
      - Therapeutic anticoagulation Therapeutic anticoagulation
  - Further reading Further reading
  - Internet resources Internet resources
  - See also See also
- Minimal change disease Minimal change disease
  - Epidemiology Epidemiology
  - Etiology Etiology
  - Clinical presentation Clinical presentation
    - Complications of nephrotic syndrome Complications of nephrotic syndrome
      - Acute kidney injury Acute kidney injury
      - Thromboembolism Thromboembolism
      - Peritonitis Peritonitis
  - Laboratory investigations Laboratory investigations
    - Urinalysis Urinalysis
    - Blood chemistry Blood chemistry
    - Hematology Hematology
  - Pathology Pathology
  - Diagnosis Diagnosis
  - Natural history Natural history
  - Treatment Treatment
    - Initial approach Initial approach
    - Children Children
      - 1. Treatment of the first episode 1. Treatment of the first episode
      - 2. Treatment of first relapse 2. Treatment of first relapse
      - 3. Treatment of frequently relapsing or steroid-dependent disease 3. Treatment of frequently relapsing or steroid-dependent disease
      - 4. Steroid-resistant nephrotic syndrome in children 4. Steroid-resistant nephrotic syndrome in children
    - Adults Adults
      - 1. Treatment of the first episode 1. Treatment of the first episode
      - 2. Treatment of the first relapse 2. Treatment of the first relapse
      - 3. Treatment of frequently relapsing and steroid-dependent disease 3. Treatment of frequently relapsing and steroid-dependent disease
      - 4. Treatment of steroid-resistant disease 4. Treatment of steroid-resistant disease
  - Follow-up Follow-up
  - Internet resources Internet resources
  - Further reading Further reading
  - See also See also
- Focal segmental glomerulosclerosis Focal segmental glomerulosclerosis
  - Epidemiology Epidemiology
  - Etiology Etiology
    - Primary FSGS Primary FSGS
    - Secondary FSGS Secondary FSGS
      - Genetic disease Genetic disease
      - Viral-mediated FSGS Viral-mediated FSGS
      - Drug-induced FSGS Drug-induced FSGS
      - Structural maladaptive FSGS Structural maladaptive FSGS
  - Clinical presentation Clinical presentation
  - Pathology Pathology
    - FSGS not otherwise specified (NOS) (classic FSGS) FSGS not otherwise specified (NOS) (classic FSGS)
    - FSGS, perihilar variant FSGS, perihilar variant
    - FSGS, cellular variant FSGS, cellular variant
    - FSGS, collapsing variant (collapsing glomerulopathy) FSGS, collapsing variant (collapsing glomerulopathy)
    - FSGS, tip variant FSGS, tip variant
    - Other variants of FSGS Other variants of FSGS
      - C1q nephropathy C1q nephropathy
      - FSGS with diffuse mesangial hypercellularity FSGS with diffuse mesangial hypercellularity
    - Secondary FSGS Secondary FSGS
      - HIV-associated disease HIV-associated disease
      - Structural maladaptive FSGS Structural maladaptive FSGS
  - Diagnosis Diagnosis
  - Natural history Natural history
  - Treatment Treatment
    - General treatment General treatment
    - Disease-specific treatment Disease-specific treatment
      - Who to treat Who to treat
    - Initial treatment approach Initial treatment approach
      - Relapsing disease Relapsing disease
    - Second-line treatment Second-line treatment
      - Ciclosporin Ciclosporin
      - Cytotoxic agents Cytotoxic agents
      - Mycophenolate mofetil Mycophenolate mofetil
      - Tacrolimus Tacrolimus
      - Sirolimus Sirolimus
      - Rituximab Rituximab
      - Plasmapheresis Plasmapheresis
  - Follow-up Follow-up
  - Recurrent FSGS post-transplantation Recurrent FSGS post-transplantation
    - Treatment Treatment
  - Further reading Further reading
  - Internet resources Internet resources
  - See also See also
- Immunoglobulin A nephropathy and Henoch–Schönlein purpura Immunoglobulin A nephropathy and Henoch–Schönlein purpura
  - IgA nephropathy IgA nephropathy
    - Epidemiology Epidemiology
    - Etiology Etiology
    - Natural history Natural history
    - Clinical features Clinical features
      - Symptoms Symptoms
      - Signs Signs
    - Differential diagnosis Differential diagnosis
    - Investigations Investigations
      - General investigations General investigations
      - Special investigations Special investigations
      - Renal biopsy features Renal biopsy features
    - Risk stratification Risk stratification
    - Treatment Treatment
      - General measures General measures
      - Recurrent macroscopic hematuria Recurrent macroscopic hematuria
      - Microscopic hematuria and <1 g/24 h proteinuria Microscopic hematuria and <1 g/24 h proteinuria
      - Nephrotic syndrome Nephrotic syndrome
      - Acute kidney injury Acute kidney injury
      - Slowly progressive IgAN Slowly progressive IgAN
    - Follow-up Follow-up
      - Pregnancy Pregnancy
    - Prognosis Prognosis
    - Future prospects Future prospects
  - Henoch–Schönlein purpura Henoch–Schönlein purpura
    - Epidemiology Epidemiology
    - Etiology Etiology
    - Natural history Natural history
    - Clinical features Clinical features
      - Symptoms Symptoms
      - Signs Signs
    - Differential diagnosis Differential diagnosis
    - Investigations Investigations
      - General investigations General investigations
      - Special investigations Special investigations
      - Renal biopsy features Renal biopsy features
    - Risk stratification Risk stratification
    - Treatment Treatment
      - General measures General measures
      - Specific treatment Specific treatment
    - Follow-up Follow-up
    - Prognosis Prognosis
    - Future prospects Future prospects
  - Further reading Further reading
  - Internet resources Internet resources
  - See also See also
- Membranous nephropathy Membranous nephropathy
  - Definition Definition
  - Epidemiology Epidemiology
  - Etiology Etiology
    - Primary (‘idiopathic’) MN Primary (‘idiopathic’) MN
    - Secondary MN Secondary MN
      - Malignancy Malignancy
      - Systemic lupus erythematosis (SLE) Systemic lupus erythematosis (SLE)
      - Infection Infection
      - Drugs Drugs
      - Renal transplantation Renal transplantation
  - Pathogenesis Pathogenesis
  - Natural history Natural history
  - Symptoms and signs Symptoms and signs
  - Differential diagnosis Differential diagnosis
  - General investigations General investigations
  - Special investigations Special investigations
  - Renal biopsy findings Renal biopsy findings
    - Light microscopy Light microscopy
    - Immunohistology Immunohistology
    - Electron microscopy Electron microscopy
    - Staging Staging
    - Important histological variants Important histological variants
      - Focal sclerosis Focal sclerosis
      - Glomerular crescents Glomerular crescents
      - Atypical deposits Atypical deposits
      - Panimmunoreactivity Panimmunoreactivity
  - Risk stratification Risk stratification
  - Patient advice Patient advice
    - General General
    - Pregnancy Pregnancy
  - Pharmacological treatment Pharmacological treatment
    - Nonspecific measures Nonspecific measures
      - Secondary hyperlipidemia Secondary hyperlipidemia
      - Anticoagulation Anticoagulation
      - Decrease urinary protein excretion Decrease urinary protein excretion
    - Disease-specific measures Disease-specific measures
      - Corticosteroids plus chlorambucil Corticosteroids plus chlorambucil
      - Corticosteroids + cyclophosphamide Corticosteroids + cyclophosphamide
      - Ciclosporin Ciclosporin
      - Alternative third-line strategies Alternative third-line strategies
    - Underlying disease Underlying disease
      - Malignancy Malignancy
      - Systemic lupus erythematosis Systemic lupus erythematosis
      - HBV HBV
      - Drugs Drugs
  - Prognosis and follow-up Prognosis and follow-up
    - Idiopathic MN Idiopathic MN
    - Secondary MN Secondary MN
      - Malignancy Malignancy
      - Systemic lupus erythematosis Systemic lupus erythematosis
      - HBV HBV
      - Drugs Drugs
      - Renal transplantation Renal transplantation
  - Further reading Further reading
  - Internet resources Internet resources
  - See also See also
- Mesangiocapillary glomerulonephritis Mesangiocapillary glomerulonephritis
  - Definition Definition
  - Epidemiology Epidemiology
  - Etiology Etiology
    - MCGN type I is associated with: MCGN type I is associated with:
    - MCGN type II is associated with: MCGN type II is associated with:
    - MCGN type III MCGN type III
  - Pathogenesis Pathogenesis
    - MCGN types I and III MCGN types I and III
    - MCGN type II MCGN type II
  - Natural history Natural history
  - Symptoms and signs Symptoms and signs
  - Differential diagnosis Differential diagnosis
  - General investigations General investigations
  - Special investigations Special investigations
    - MCGN type I MCGN type I
    - MCGN type II MCGN type II
    - MCGN type III MCGN type III
  - Renal biopsy findings Renal biopsy findings
    - Light microscopy Light microscopy
    - Immunohistology Immunohistology
    - Electron microscopy Electron microscopy
  - Risk stratification Risk stratification
  - Patient advice Patient advice
    - General General
    - Pregnancy Pregnancy
  - Pharmacological treatment Pharmacological treatment
    - Nonspecific measures Nonspecific measures
      - Secondary hyperlipidemia: Secondary hyperlipidemia:
      - Decrease urinary protein excretion: Decrease urinary protein excretion:
      - Anticoagulation: Anticoagulation:
    - Disease-specific measures Disease-specific measures
    - MCGN type I MCGN type I
      - Corticosteroids (in children) Corticosteroids (in children)
      - Antiplatelet agents Antiplatelet agents
      - Alkylating agents Alkylating agents
      - Alternative strategies Alternative strategies
    - MCGN type II MCGN type II
    - Underlying disease Underlying disease
      - HCV HCV
      - SLE and rheumatological diseases SLE and rheumatological diseases
      - HBV HBV
  - Prognosis and follow-up Prognosis and follow-up
    - MCGN type I MCGN type I
    - MCGN type II MCGN type II
    - MCGN type III MCGN type III
    - Recurrent disease post-transplantation Recurrent disease post-transplantation
  - References References
  - Internet resources Internet resources
  - See also See also
- Acute endocapillary glomerulonephritis Acute endocapillary glomerulonephritis
  - Definition Definition
  - Epidemiology Epidemiology
  - Etiology Etiology
  - Pathogenesis Pathogenesis
    - PSGN PSGN
    - Nonstreptococcal infection-associated glomerulonephritis Nonstreptococcal infection-associated glomerulonephritis
  - Natural history Natural history
  - Symptoms and signs Symptoms and signs
  - Differential diagnosis Differential diagnosis
  - General investigations General investigations
  - Special investigations Special investigations
  - Renal biopsy findings Renal biopsy findings
    - Light microscopy Light microscopy
    - Immunofluorescence Immunofluorescence
    - Electron microscopy Electron microscopy
  - Risk stratification Risk stratification
  - Patient advice Patient advice
    - General General
  - Pharmacological treatment Pharmacological treatment
    - Nonspecific measures Nonspecific measures
      - Secondary hyperlipidemia: Secondary hyperlipidemia:
      - Decrease urinary protein excretion: Decrease urinary protein excretion:
      - Anticoagulation: Anticoagulation:
    - Supportive measures Supportive measures
    - Disease-specific measures Disease-specific measures
  - References References
  - See also See also
- Crescentic glomerulonephritis Crescentic glomerulonephritis
  - Definitions Definitions
  - Classification Classification
  - Pathogenesis Pathogenesis
  - Differential diagnosis Differential diagnosis
  - Etiology and epidemiology Etiology and epidemiology
  - Clinical presentation Clinical presentation
  - Investigations in CGN Investigations in CGN
    - Renal biopsy Renal biopsy
    - Serological investigations Serological investigations
    - Other investigations Other investigations
  - General management principles General management principles
  - Individual management principles Individual management principles
    - Pauci-immune CGN Pauci-immune CGN
    - Anti-GBM disease Anti-GBM disease
    - Immune complex disease Immune complex disease
  - Further reading Further reading
  - Internet resources Internet resources
  - See also See also
- Antiglomerular basement membrane (Goodpasture's) disease Antiglomerular basement membrane (Goodpasture's) disease
  - Epidemiology Epidemiology
  - Etiology Etiology
  - Pathogenesis Pathogenesis
    - Humoral immunity Humoral immunity
    - Cell-mediated immunity Cell-mediated immunity
  - Disease associations Disease associations
  - Clinical features Clinical features
  - Investigations Investigations
  - Renal biopsy Renal biopsy
  - Treatment Treatment
    - Standard therapy Standard therapy
    - Alternative therapy Alternative therapy
    - Who should be immunosuppressed? Who should be immunosuppressed?
    - Adjunctive therapeutic strategies Adjunctive therapeutic strategies
  - Disease outcome Disease outcome
  - Renal transplantation Renal transplantation
  - Alport's syndrome and post-transplantation anti-GBM disease Alport's syndrome and post-transplantation anti-GBM disease
  - Further reading Further reading
  - See also See also
- Infection-related glomerulonephritis Infection-related glomerulonephritis
  - Bacterial infections Bacterial infections
    - Post-streptococcal GN (PSGN) Post-streptococcal GN (PSGN)
      - Epidemiology Epidemiology
      - Etiology/pathogenesis Etiology/pathogenesis
      - Clinical features Clinical features
      - Diagnosis Diagnosis
      - Treatment Treatment
      - Prognosis Prognosis
    - Endocarditis-associated GN Endocarditis-associated GN
      - Epidemiology Epidemiology
      - Etiology/pathogenesis Etiology/pathogenesis
      - Clinical features Clinical features
      - Diagnosis Diagnosis
      - Treatment Treatment
      - Prognosis Prognosis
    - Shunt nephritis Shunt nephritis
      - Epidemiology Epidemiology
      - Etiology/pathogenesis Etiology/pathogenesis
      - Clinical features Clinical features
      - Diagnosis Diagnosis
      - Treatment Treatment
      - Prognosis Prognosis
  - Viral infections Viral infections
    - Hepatitis B virus (HBV) Hepatitis B virus (HBV)
      - Serum sickness Serum sickness
      - Polyarteritis nodosa (PAN) Polyarteritis nodosa (PAN)
      - Membranous nephropathy (MN) Membranous nephropathy (MN)
      - MCGN MCGN
    - Hepatitis C virus (HCV) Hepatitis C virus (HCV)
      - Epidemiology Epidemiology
      - Pathogenesis Pathogenesis
      - Clinical features Clinical features
      - Diagnosis Diagnosis
      - Prognosis Prognosis
      - Treatment Treatment
    - Human immunodeficiency virus (HIV) Human immunodeficiency virus (HIV)
      - HIV-associated nephropathy HIV-associated nephropathy
      - Lupus-like syndrome Lupus-like syndrome
      - HIV-associated thrombotic microangiopathy HIV-associated thrombotic microangiopathy
  - Parasitic infections Parasitic infections
    - Malaria Malaria
      - Epidemiology Epidemiology
      - Clinical features Clinical features
    - Schistosomiasis Schistosomiasis
    - Filaria Filaria
    - Others Others
  - Further reading Further reading
  - Internet resources Internet resources
  - See also See also
- Malignancy-associated glomerular disease Malignancy-associated glomerular disease
  - Epidemiology Epidemiology
  - Pathogenesis Pathogenesis
  - Clinical features Clinical features
  - Specific glomerular disorders Specific glomerular disorders
    - Membranous nephropathy (MN) Membranous nephropathy (MN)
      - Histological findings in MN Histological findings in MN
    - Minimal change disease (MCD) Minimal change disease (MCD)
    - Focal segmental glomerulosclerosis (FSGS) Focal segmental glomerulosclerosis (FSGS)
    - Amyloidosis Amyloidosis
      - Histological finding in amyloidosis Histological finding in amyloidosis
    - Crescentic glomerulonephritis Crescentic glomerulonephritis
    - Mesangiocapillary GN (MCGN) Mesangiocapillary GN (MCGN)
    - IgA nephropathy IgA nephropathy
  - Thrombotic microangiopathy Thrombotic microangiopathy
  - Treatment Treatment
  - Screening for malignancy Screening for malignancy
  - Conclusions Conclusions
  - Further reading Further reading
  - See also See also
- Glomerular disease in the tropics Glomerular disease in the tropics
  - Epidemiology Epidemiology
  - Acute nephritic syndrome Acute nephritic syndrome
    - Etiology Etiology
    - Pathogenesis Pathogenesis
    - Clinical course Clinical course
    - Diagnosis Diagnosis
      - Urinalysis Urinalysis
      - Serology Serology
      - Renal biopsy Renal biopsy
    - Differential diagnosis Differential diagnosis
    - Treatment Treatment
    - Prognosis Prognosis
    - Follow-up Follow-up
  - Nephrotic syndrome (NS) Nephrotic syndrome (NS)
    - Etiology Etiology
      - Quartan malarial nephrotic syndrome (QMNS) Quartan malarial nephrotic syndrome (QMNS)
      - Falciparum malaria Falciparum malaria
      - Hepatitis B virus (HBV)-associated GN Hepatitis B virus (HBV)-associated GN
      - Hepatitis C virus (HCV)-associated GN Hepatitis C virus (HCV)-associated GN
      - HIV-associated renal disease HIV-associated renal disease
      - Sickle cell-associated renal disease Sickle cell-associated renal disease
      - Leprosy-associated GN Leprosy-associated GN
      - Other forms of secondary GN Other forms of secondary GN
  - Further reading Further reading
  - Internet resources Internet resources
  - See also See also
- Notes
- Notes
4 The kidney in systemic disease
- Notes
- Notes
5 Tubular disease
- Notes
- Notes
6 Chronic interstitial disease
- Notes
- Notes
7 Urinary tract infection
- Notes
- Notes
8 Renal stone disease
- Notes
- Notes
9 Hypertension
- Notes
- Notes
10 Acute kidney injury (AKI)
- Notes
- Notes
11 Chronic kidney disease (CKD)
- Notes
- Notes
12 Special problems in chronic kidney disease
- Notes
- Notes
13 Dialysis
- Notes
- Notes
14 Renal transplantation
- Notes
- Notes
15 Inherited renal disease
- Notes
- Notes
16 Structural and congenital abnormalities
- Notes
- Notes
17 Malignancy of the kidney and urinary tract
- Notes
- Notes
18 Pharmacology and drug use in kidney disease
- Notes
- Notes
- Appendix
  - Notes
  - Notes
- Index
  - Notes
  - Notes

Chapter

3 Glomerular disease

Get access

https://doi.org/10.1093/med/9780199229567.003.0003

Pages

75–142

Published:

November 2008

Extract

Chapter contents

...

Proteinuria and/or hematuria

General principles

Proteinuria and hematuria are two cardinal features of kidney disease.

Urine dipstick testing to detect them is simple and widely available.

Persistent proteinuria or hematuria is much more likely to indicate significant renal disease.

The combination of proteinuria and hematuria is more likely to indicate significant and potentially progressive kidney disease than either alone.

Urine testing is mostly opportunist.

Symptomless individuals often have a urine test if they require medical approval for some key life event, e.g. life insurance, employment, entry into armed forces.

Screening is only for high risk populations, e.g. those patients with diabetes, hypertension, cardiovascular disease, family history of renal disease.

Not all people with kidney disease have proteinuria or hematuria.

Proteinuria is most characteristic of glomerular disease. In tubulointerstitial and vascular renal parenchymal disease, proteinuria often develops later or not at all.

Not all people with proteinuria or hematuria have kidney disease. Hematuria has many other possible causes in the renal tract.

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Oxford University Press makes no representation, express or implied, that the drug dosages in this book are correct. Readers must therefore always … More

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Contents

3 Glomerular disease

Extract

Chapter contents

Proteinuria and/or hematuria

General principles

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Contents

3 Glomerular disease

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Chapter contents

Proteinuria and/or hematuria

General principles

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