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Glomerular disease: Evaluation and differential diagnosis in adults

Author
Jai Radhakrishnan, MD, MS
Section Editors
Richard J Glassock, MD, MACP
Brad H Rovin, MD
Deputy Editor
Albert Q Lam, MD

INTRODUCTION

Glomerular disease can result from many inherited or acquired disorders and can manifest in a variety of ways, ranging in severity from asymptomatic urinary abnormalities to acute kidney injury (AKI) or end-stage renal disease.

A kidney biopsy is often required to secure the underlying diagnosis in a patient with suspected glomerular disease, particularly in patients with nephrotic syndrome or suspected glomerulonephritis. Rarely, a biopsy cannot be performed or is not needed to secure a diagnosis. As examples:

A biopsy may be deferred if the procedural risk is prohibitive or if the patient is uncooperative or unwilling. In such cases, a presumptive diagnosis can sometimes be made without a biopsy to facilitate the initiation of therapy. However, a biopsy should often be performed at a later date if it becomes feasible. (See "Indications for and complications of renal biopsy".)

A biopsy may not be required if a definitive diagnosis can be made by serology (eg, patients with nephrotic syndrome due to membranous nephropathy associated with anti-phospholipase A2 receptor [anti-PLA2R] autoantibodies). (See "Causes and diagnosis of membranous nephropathy".)

More than one glomerular disease can be present in the same individual (eg, underlying diabetic nephropathy with superimposed glomerulonephritis).

                     
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Literature review current through: Nov 2017. | This topic last updated: Sep 26, 2017.
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