Glomerular Disease

Glomerulonephritis (GN)

Definition (Lancet 2016;387:2036; JASN 2016;27:1278)

  • ↑ glomerular inflammation → endothelial & podocyte injury
  • Histology: proliferative (↑ cells), sclerosing (scar), necrotizing (areas cell death). Focal (<50% of glomeruli) to diffuse to crescentic. Segmental (<50% tuft) to global (100%).
  • Clinically: hematuria w/ dysmorphic RBCs or RBC casts, ± subnephrotic proteinuria
    • often w/ AKI, HTN, edema
  • Progression: acute ≈ days; rapidly progressive (RPGN) ~6 wk; chronic ≈ mos; can be asx
  • Crescentic GN (pathologic description) ≈ RPGN (clinical description)
ANCAVasculitis (pauci-immune, minimal staining) ~40–45% of total
Pathogen: infxn, drug ral, allopurinol, contam cocaine) (