Clinical Aspects of Glomerular Disease Pathological Classifications of Glomerular Diseases • Minimal Change GN • Focal segmental glomerulosclerosis (FSGS) • Membranous GN • Mesangiocapillary GN • IgA Nephropathy (IgAN) • Anti-glomerular BM disease (Anti-GMB disease/Goodpasture syndrome) • Degenerative glomerular disease • Alport’s disease • Diabetic nephropathy • Lupus nephritis (SLE) Spectrum of Glomerular Injury • Mild Selective proteinuria e.g. albuminuria only with no loss of GFR o Isolated microscopic haematuria without albuminuria or loss of GFR o • Moderate o Low grade damage or inflammation o Albuminuria and haematuria o May cause progressive loss of GFR and CKD o Inflammatory forms may paradoxically not respond to immunosuppressants • Aggressive o Rapid loss of renal function o Massive haematuria (glomerular, sometimes visible) o Greater response to immunosuppressants if initiated early Mechanisms of Glomerular Injury • Autoimmune o Largest group o Immune overactivity o Damage to glomerular structures by immune components  Antibodies, complement, cytokines • Degenerative o Age or injury related nephrosclerosis • Metabolic o Diabetes, amyloidosis, Fabry’s disease • Genetic o Alport’s disease, familial forms of glomerular diseases • Idiopathic • Congenital: most uncommon e.g. glomerulocystic Clinical Syndromes Associated with Glomerular Disease • Acute: Painless macroscopic haematuria and flank pain o Nephrotic syndrome o Nephritic syndrome  Chronic: o o Symptomatic CKD o Asymptomatic CKD