Glomerular disease
This page contains general information about Glomerular disease.
For more information on specific types, please visit the pages on:

# Overview
Glomerular disease is a condition that affects the glomerulus. It consists of different diseases with different clinical courses and treatment options. Glomerular disease can be isolated hematuria, isolated proteinuria; acute or chronic glomerulonephritis, and nephrotic or nephritic features of glomerulonephritis. The end stage of all of these diseases will be glomerulosclerosis which is characterized by fibrosis of the glomerulus, and end-stage renal disease.

# Classification

## Glomerular dieseases can be classified into several clinical and pathological syndromes as below:

## Also, glomerular diseases can be classified based on their clinical and urinary pattern in to below types:

### Mild nephritc:
This category include mild nephritic sediment that is associated with less than half involvement of glomeruli.

### Severe nephritic:
More severe clinical features such as edema, heavy proteinuria, hypertension, and/or renal failure may occur.

### Nephrotic:
This syndrome is associated with heavy proteinuria and lipiduria.

## Glomerular diseases also may classified by their presentation as below:
1- Isolated hematuria
2- Glomerulonephritis (nephritic syndrome)
1-Isolated non-nephrotic proteinuria
2- Nephrotic syndrome

## Glomerulonephritis
Glomerulonephritis which is inflammation of the glomeruli can be classified based on pathogenic type into three subtypes:
- Immune complex glomerulonephritis: Granular deposit of immune complex.
Infection mediated types
Autoimmune types, eg SLE
MPGN
IgA nephropathy (Berger nephropathy)
Membranous nephropathy
- Infection mediated types
- Autoimmune types, eg SLE
- MPGN
- IgA nephropathy (Berger nephropathy)
- Membranous nephropathy
- Anti-GBM disease: Linear deposit
Goodpasture syndrome (renal and lung involvement)
Renal involvement alone
Lung involvement alone
- Goodpasture syndrome (renal and lung involvement)
- Renal involvement alone
- Lung involvement alone
- ANCA associated, small vessels vasculitis: Few or no deposit
Granulomatosis with polyangiitis (Wegener granulomatosis)
Eosinophilic granulomatosis with polyangiitis (Churg-Strauss syndrome)
Microscopic polyangiitis
- Granulomatosis with polyangiitis (Wegener granulomatosis)
- Eosinophilic granulomatosis with polyangiitis (Churg-Strauss syndrome)
- Microscopic polyangiitis
Glomerulonephritis (nephritic syndrome) also may be classified based on disease course into acute or chronic nephritic syndrome; primary vs secondary causes; or systemic vs renal limited disease. For more information about nephritic syndrome classifications click here.

# Differential Diagnosis
The various types of glomerular diseases should be differentiated from each other based on associations, presence of pitting edema, hematuria, hypertension, hemoptysis, oliguria, peri-orbital edema, hyperlipidemia, type of antibodies, light and electron microscopic features. The following table differentiates between various types of glumerular diseases:
Some infectious diseases such as HIV, HBV, HCV, syphilis, leprosy, malaria, and schistosomiasis may cause glomerular diseases.

# Images
Image courtesy of Professor Peter Anderson DVM PhD and published with permission  PEIR, University of Alabama at Birmingham, Department of Pathology
- This is a low-power photomicrograph of a saggital section of end stage chronic glomerulonephritis (GN). Note the marked thinning of the cortex (arrow).
- This is a higher-power photomicrograph of hyalinized glomeruli (arrows) and glomeruli with thick basement membranes.
- This is a higher-power photomicrograph of hyalinized glomeruli (1) and glomeruli with thickened basement membranes (2).
- This is a photomicrograph of interstitial and vascular lesions in end stage renal disease.
- This is an immunofluorescent photomicrograph of granular membranous immunofluorescence (immune complex disease). The antibody used for these studies was specific for IgG.
- This is an electron micrograph of subepithelial granular electron dense deposits (arrows) which correspond to the granular immunofluorescence seen in the previous image.
- This is a photomicrograph of a glomerulus from another case with acute poststreptococcal glomerulonephritis. In this case the immune complex glomerular disease is ongoing with necrosis and accumulation of neutrophils in the glomerulus.
- This immunofluorescent photomicrograph of a glomerulus from a case of acute poststreptococcal glomerulonephritis shows a granular immunofluorescence pattern consistent with immune complex disease. The primary antibody used for this staining was specific for IgG; however antibodies for complement would show a similar pattern.
- This electron micrograph demonstrates scattered subepithelial dense deposits (arrows) and a polymorphonuclear leukocyte in the lumen.
- For comparison this is an immunofluorescent photomicrograph of a glomerulus from a patient with Goodpasture's syndrome. The linear (arrows) immunofluorescence is characteristic of Goodpasture's syndrome.

## Microscopic Pathology
Images shown below are courtesy of Professor Peter Anderson DVM PhD and published with permission  PEIR, University of Alabama at Birmingham, Department of Pathology
- Glomerulonephritis: Micro H&E med mag; an excellent example of AGN with many neutrophils
- Acute Glomerulonephritis: Micro H&E high mag; an  excellent example of acute exudative glomerulonephritis.

## Glomerulonephritis Videos

### Rapidly progressive glomerulonephritis

### Chronic glomerulonephritis

## Images:
- Crescentic GN
- Chronic GN