Glomerular disease: Evaluation and differential diagnosis in adults
- Jai Radhakrishnan, MD, MS
Jai Radhakrishnan, MD, MS
- Professor of Medicine
- Columbia University Medical Center
- Section Editors
- Richard J Glassock, MD, MACP
Richard J Glassock, MD, MACP
- Editor-in-Chief — Nephrology
- Section Editor — Glomerular Diseases
- Emeritus Professor
- The David Geffen School of Medicine at UCLA
- Brad H Rovin, MD
Brad H Rovin, MD
- Section Editor — Glomerular Diseases
- Professor of Medicine and Pathology
- The Ohio State University College of Medicine
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).To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information on subscription options, click below on the option that best describes you:
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- GLOMERULAR ANATOMY AND TERMINOLOGY
- CLINICAL MANIFESTATIONS OF GLOMERULAR DISEASE
- EVALUATION AND DIFFERENTIAL DIAGNOSIS OF MAJOR GLOMERULAR PRESENTATIONS
- - Nephrotic syndrome (heavy proteinuria and hypoalbuminemia)
- Evaluation of nephrotic syndrome
- Differential diagnosis of nephrotic syndrome
- - Proteinuria without nephrotic syndrome
- Evaluation of proteinuria without nephrotic syndrome
- Differential diagnosis of proteinuria without nephrotic syndrome
- Glomerular hematuria
- - Glomerulonephritis (hematuria with proteinuria, renal insufficiency, or other manifestations)
- Evaluation of glomerulonephritis
- Differential diagnosis of glomerulonephritis
- - Isolated glomerular hematuria
- Evaluation of isolated glomerular hematuria
- Differential diagnosis of isolated glomerular hematuria
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