Glomerular disorders are classified based on the urine changes, manifested mainly in
The main characteristic of glomerular disease is proteinuria, which is often in the nephrotic range (? 3 g / day). Glomerular disorders are classified based on the urine changes that manifest themselves primarily with proteinuria in the nephrotic range and nephrotic urine sediment (oily cylinder, oval fat body, but only a few cells or cellular cylinder) hematuria, usually in combination with proteinuria (which may be in nephritic area ); the red blood cells are dysmorphic usually and often are red blood cells or mixed cellular cylinders available. Nephrotic syndrome is characterized by nephrotic urine sediment and edema and hypoalbuminemia (typically with hypercholesterolemia and hypertriglyceridemia). A nephritic syndrome is characterized by nephritic urine sediment with or without hypertension, elevated serum creatinine and oliguria. Some glomerular disorders manifest themselves typically both nephritic and with nephrotic syndrome. These disorders include the fibrillar and immunotaktoide glomerulonephritis membranoproliferative glomerulonephritis (GN) and lupus nephritis, but are not limited to these. The pathophysiology of nephritic and nephrotic disorders is significantly different, but their clinical presentation can significantly overlap – this is how some diseases such. B. represent the same clinical picture – and saw the presence of hematuria or proteinuria for itself says nothing about the response to treatment or prognosis. Disorders tend to manifest themselves at different ages (see Table: Glomerular disorders by age and manifestations) though there are many overlaps. These disorders may be primary (idiopathic) Secondary See Table: Causes of glomerulonephritis and see table: causes of nephrotic syndrome) Glomerular disorders by age and manifestations age (years) Nephritic syndrome nephrotic syndrome Mixed Nephritic and nephrotic syndrome <15 Weak Pign IgA nephropathy Thin basement membrane hereditary nephritis IgA-associated vasculitis lupus nephritis Congenital nephrotic syndrome minimal-change Kr ankheit focal segmental sclerosing glomerulonephritis lupus nephritis (membranous subtype) Membranoproliferative lupus nephritis GN 15-40 IgA nephropathy thin basement membrane nephritis Hereditary Nephritis related RPGN Pign focal segmental sclerosing glomerulonephritis in lupus nephritis (membranous subtype) minimal-change disease membranous nephropathy diabetic nephropathy Late pre-eclampsia Pign IgA nephropathy Membranoproliferative GN fibrillary and immunotaktoide GN * IgA nephropathy lupus nephritis RPGN> 40 IgA nephropathy RPGN Vasculitis Pign focal segmental sclerosing glomerulonephritis membranous nephropathy Diabetic nephropathy minimal-change disease IgA nephropathy amyloidosis (primary) “Light chain deposition disease” Benign hypertensive arteriolar nephrosclerosis (is proteinuria usually <1 g / day) Late Pign IgA nephropathy fibrillar and immunotaktoide GN * * RPGN Manifested often than nephrotic syndrome. GN = glomerulonephritis; Pign = post-infectious glomerulonephritis; RPGN = rapidly progressive glomerulonephritis. Adapted from Rose BD: Pathophysiology of Renal Disease, ed 2. New York, McGraw-Hill, 1987, p 167. diagnosis serum creatinine and urinalysis Glomerular disease is usually suspected when or targeted at a routine. investigation, increased creatinine and urine pathological findings are observed (hematuria with or without cylinder, proteinuria, or both). The patient's assessment is based on the distinction principally nephritischer of mainly nephrotic signs and - depending on the age of the patient - probable causes, comorbidities, and other characteristics (see table: causes of nephrotic syndrome: Glomerular disorders by age and manifestations and see table) the history (for. example, time course, systemic onset, family history). A kidney biopsy is indicated if the diagnosis is unclear or if the histological findings could influence the choice of therapy and the course (eg. As lupus nephritis).