Glomerular disease

Manifestations vary from asymptomatic urinary abnormalities to severe forms of rapidly progressive glomerulonephritis.

Manifestations vary from asymptomatic urinary abnormalities to severe forms of rapidly progressive glomerulonephritis.

Most patients with mild disease are diagnosed by urinary dipstick test for microhematuria or proteinuria

All patients with suspected disease need quantitation of proteinuria with 24 hour urine evaluations, protein to creatinine ratio in a random sample of urine, microscopic urinary examination, and serum creatinine level.

Can be the manifestation of malignancies, infections and autoimmune disorders.

Evaluation of a patient with suspected glomerular disease should have a CBC, chemistry profile, urinalysis, evaluation or microscopic hematuria, proteinuria, protein electrophoresis, serum immunoglobulin levels, serum complement levels of C3 and C4, antinuclear antibody levels, anti-DNA levels, antineutrophil cytoplasmic antibodies, tests for hepatitis B and C and HIV testing.

Definitive diagnosis and classification of disease requires renal biopsy.

Non-diabetic glomerular disease is suspected in a diabetic with previously normal renal function, short duration of diabetes, absence of retinopathy, a rapid decline in renal function, and urine sediment with cellular casts.

Diabetics may suffer from a variety of glomerular lesions including membranous nephropathy, postinfectious glomerulonephritis, IGA nephropathy’s, focal proliferative glomerulonephritis and amyloidosis as independent or superimpose conditions with concurrent diabetic nephropathy.

Glomerular disease is much more common among nonwhite persons.

Glomerulopathies account for the third most common cause of end-stage renal disease and accounts for 20-30% of the population with prevalent end-stage renal disease.

Glomerulopathies are responsible for a large portion of the $32 billion spent annually on the ESRD care in the US.

Mortality rates in glomerularnephropathies are 3 – 4 fold higher then people without kidney disease.

Even small reductions in the GFR are associated with increased cardiovascular morbidity  and mortality and reduced overall survival.

Glomerulopathies incident has increased to rates high as 2.5 cases per 100,000 person – years in the general population.

Patients with focal segmental glomerulosclerosis and IgA nephropathy have a significantly higher risk of end-stage renal disease compared with those with minimal change disease.

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