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Glomerular Diseases

Major Renal Manifestations of Glomerular Disease

Abnormal urinalysis

Only red cell casts, heavy proteinuria, and lipiduria are diagnostic minimal change disease, focal glomerulosclerosis, hematuria, lupus, diabetic nephropathy, postinfectious glomerulonephritis, membranous nephropathy, diabetic nephropathy, amyloidosis, light chain deposition disease, benign nephrosclerosis glomerulonephritis

Approach to Patient with Hematuria

Historical clues suggesting a particular underlying disease: Diabetic nephropathy Late postinfectious glomerulonephritis Membranous nephropathy Diabetic nephropathy Primary amyloidosis (primarily M)or light chain deposition disease (primarily M) Benign nephrosclerosis

Unilateral flank pain with kidney stones

Postinfectious glomerulonephritis or IgA nephropathy if post-URI

Sickle cell trait or disease

Family or personal history of renal failure or polycystic kidney disease

Glomerular versus extraglomerular bleeding

Glomerular vs Extraglomerular Bleeding

Primary characteristics of glomerular hematuria: Primary amyloidosis (primarily M)or light chain deposition disease (primarily M) Benign nephrosclerosis

Majority of red cells have dysmorphic appearance -

Red cell casts· Heavy proteinuria (primarily M)or light chain deposition disease (primarily M) Benign nephrosclerosis

· Lack of blood clots with renal bleeding, due perhaps to urokinase and TPA in tubular cells

· Brown, "Coca-cola"-colored urine may be seen; unusual with extrarenal bleeding

Diagnosis of Isolated Glomerular Hematuria

IgA nephropathy

May have recurrent episodes of gross hematuria

Generally negative family history of renal disease

Hereditary nephritis

May have gross hematuria

Family history of renal failure common

Thin basement membrane disease