339 Ch 338. Glomerular Diseases — Nephrotic and Nephritic Syndromes (Overview)

Glomerular diseases = 影響 glomerulus 的疾病；nephrotic syndrome (NS) = proteinuria > 3.5 g/24h + hypoalbuminemia (< 3.5 g/dL) + edema + hyperlipidemia ± hypercoagulability；nephritic syndrome = hematuria + RBC casts + HTN + AKI variable + edema + proteinuria (variable, often sub-nephrotic)；workup：UA + UACR + 24h urine protein + serum albumin + lipids + complement + autoimmune panel (ANA, dsDNA, ANCA, anti-GBM, anti-PLA2R, anti-THSD7A, anti-NELL-1) + hepatitis + HIV + free light chains + cryoglobulins → renal biopsy is gold standard for definitive diagnosis；common nephrotic causes：(1) minimal change disease (MCD) — children most; (2) focal segmental glomerulosclerosis (FSGS) — adults, APOL1 risk in African ancestry; (3) membranous nephropathy (MN) — most adults; primary anti-PLA2R associated, secondary causes; (4) diabetic kidney disease (DKD) — most common cause globally; (5) amyloidosis (AL, AA, hereditary); (6) light chain deposition disease；common nephritic causes：(1) IgA nephropathy — most common globally; (2) post-infectious GN (PSGN) — strep + others; (3) lupus nephritis — class I-VI; (4) ANCA-associated vasculitis — GPA, MPA, EGPA; (5) anti-GBM (Goodpasture); (6) MPGN / C3G; (7) infection-related (hep B, hep C, HIV)。