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The Spectrum of Glomerular Disease
Minimal change
Proteinuria
FSGS
IgA nephropathyMembranous
Diabetic nephropathy
MCGN
SLE
Post infectious nephritis
Anti-GBM disease
Small vessel vasculitis
Glomerular filtration barrier
Podocytes
Glomerular endothelial cells
GBM
180 litres of water and small solutes- almost no
proteins
Slit diaphragm
Definition
• Protein:creatinine ratio (PCR)– 20mg/mmol– 200mg/mmol nephrotic range
• Albumin: creatinine ratio (ACR)– 30mg/mmol
Case-1
• 13 year old boy• No PMH/FH renal disease• BP and renal function normal• Incidental finding
– Urinalysis: 2+protein– Mild proteinuria (PCR 20-50)
• 3 early morning urines: PCR• Orthostatic proteinuria
Case-2
• 5 year old boy• BP and renal function normal• Urinalysis 2+ protein, 2+ blood
– PCR 40-50– ACR 20– Calcium:creatinine: 1.5mmol/mmol– USS: Nephrocalcinosis
• NAG/RBP:creatinine• Dent’s disease: CLC5/OCRL-1 mutations
Case-3
• 8 year girl– PMH: Bilateral VUR and recurrent UTI– FH: VUR
• DMSA: Bilateral renal scarring• BP normal, eGFR 65ml/min/1.73m2
• Urinalysis 2+ protein PCR 30-50
• Enalapril 5mg od• Renal function before and at 2 weeks• Reflux nephropathy
Case-4
• 8 year old girl• HSP• Urinalysis: Protein 3+, blood 2+• PCR 100-150: Persistent at 4 weeks• BP 95th centile• Normal renal function
• Renal biopsy: Crescentic GN, IgA deposition• Steroids/Azathioprine/Enalapril• HSP nephritis