Glomerular Disease Patterns

Question 1

What are the presentations of glomerular disease?

Answer 1

1. Asymptomatic
2. Macrohematuria
3. Nephrotic syndrome
4. Nephritic syndrome (acute glomerulonephritis)
5. Rapidly progressive glomerulonephritis (RPGN)
6. Chronic kidney disease: chronic glomerulonephritis

Question 2

What indicates a biopsy in glomerular disease?

Answer 2

1. Asymptomatic urine abnormalities:
   (1) Proteinuria > 500 mg/24 hrs
   +
   Microhematuria (≥3 RBC/HPF),
   (OR)
   (2) Proteinuria >1 g/24 hrs.
   ————————————————-
2. Macrohematuria with:
   ≥40% dysmorphic RBCs,
   ≥5% acanthocytes,
   ≥1 RBC cast,
   and
   significant proteinuria
   (These features suggest Glomerular hematuria)

Question 3

What are the criteria for nephrotic syndrome?

Answer 3

1. Nephrotic range proteinuria,
2. Hypoalbuminemia (<3 g/dL),
3. Edema (extravascular).

Adults: all 3 needed.
Children: 1 + (2 or 3)

Question 4

What is considered nephrotic range proteinuria?

Answer 4

Adults: >3500 mg/24 hrs.
Children: >50 mg/kg/day

Question 5

What is the urine protein creatinine ratio (PCR) cutoff for nephrotic range?

Answer 5

Adults: ≥3000 mg/g.
Children: ≥2000 mg/g

Question 6

Is a high protein creatinine ratio diagnostic of nephrotic syndrome?

Answer 6

No, it is not diagnostic .Nephrotic range proteinuria can occur in other conditions also

Like: DM, Amyloidosis, Secondary Focal segmental glomerulosclerosis

Question 7

In which other conditions can nephrotic range proteinuria be seen other than Nephrotic syndrome ?

Answer 7

Diabetes (most common)
secondary FSGS
amyloidosis