Glomerulonephritis differential diagnosis

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Glomerulonephritis Main page

Glomerulonephritis patient information

Overview

Classification

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Pathophysiology

Differential Diagnosis

Screening

Diagnosis

Prevention

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Syed Hassan A. Kazmi BSc, MD [2]

Overview

Glomerulonephritis may be proliferative or non-proliferative and may be associated with nephrotic or nephritic features. The various types of glomerulonephritides should be differentiated from each other based on associations, presence of pitting edema, hemeturia, hypertension, hemoptysis, oliguria, peri-orbital edema, hyperlipidemia, type of antibodies, light and electron microscopic features.

Differential Diagnosis

The following table differentiates between various types of glomerulonephritides:

Glomerulonephritis Sub-entity Causes and associations History and Symtoms Laboratory Findings
Hyperlipidemia and hypercholesterolemia Nephrotic features Nephritic features ANCA Anti-glomerular basement membrane antibody (Anti-GBM antibody) Immune complex formation Light microscope Electron microscope Immunoflourescence pattern
History Pitting edema Hemeturia (pre-dominantly microscopic) Hypertension Hemoptysis Oliguria Peri-orbital edema
Non-proliferative Minimal change disease
  • Idiopathic
  • Protein tyrosine phosphatase receptor type O (glomerular epithelial protein 1- GLEPP1)
  • Young children
  • Recent infection and immunization
  • Atopy
  • Hodgkin lymphoma
  • Thrombosis (due to urinary loss of antithrombin-III)

+

-

-

-

+/-

-

+

+

-

-

-

-

  • Normal
  • Fusion of podocytes

-

Focal segmental glomerulosclerosis
  • Idiopathic
  • HIV
  • Heroine use
  • Sickle cell disease
  • Interferon
  • Severe obesity
  • Mixed cryoglobunemia (Hepatitis C)
  • Adults
+ - - - +/- - + + - - - -
  • Focal (some glomeruli) and segmental (only part of glomerulus)
  • Effacement of podocytes
-
Membranous glomerulonephritis
  • Idiopathic
  • Hepatitis B and C
  • Solid tumors
  • Systemic lupus erythmatosus
  • Drugs (NSAIDS, penclliamine, gold, captopril)
+ - - - +/- - + + - - - +
  • Thick glomerular basement membrance
  • Sub-epithelial immune complex depositis with 'spike and dome' appearance
-
Proliferative IgA nephropathy
  • Idiopathic
  • Viral infections
  • Young children
  • History of mucosal infections (e.g. gastroenteritis) and upper respiratory tract infection
  • 2-3 days after infection (synpharyngitic)
+/- + + - + +/- - - + - - +
  • Crescent formation
  • Mesangial proliferation
-
Rapidly progressive glomerulonephritis
  • Goodpasture syndrome
  • Young adults
+/- + + + + + - - + - + +
  • Hypercellular and inflamed glomeruli (Crescent formation)
  •  Diffuse thickening of the glomerular basement membrane with absence of subepithelial and subendothelial deposits 
+ (Linear)
  • Post infectious glomerulonephritis
  • Streptococcal skin infections
  • Streptococcal pharyngitis
  • 2-3 weeks after infection
+/- + + + + + - - + - - +
  • Hypercellular and inflamed glomeruli
  • Sub-epithelial immune complex deposits
+ (Granular)
  • Granulomatosis with polyangitis (Wegner's granulomatosis)
+/- + + + + + - - + + (C-ANCA) - -
  • Hypercellular and inflamed glomeruli (Crescent formation)
- (pauci-immune) +/-
  • Churg Strauss syndrome
  • Necrotizing granulomas (Lungs and kidneys)
  • Asthma
  • Peripheral neuropathy
+/- + + + + + - - +

+ (C-ANCA)

- -
  • Hypercellular and inflamed glomeruli (Crescent formation)
- (pauci-immune) -
  • Microscopic polyngitis
  • Necrotizing vasculitis (no granuloma)
+/- + + + + + - - +

+ (P-ANCA)

- -
  • Hypercellular and inflamed glomeruli (Crescent formation)
- (pauci-immune) -
Membranoproliferative glomerulonephritis
  • Idiopathic
  • Hepatitis B and C (Type 1)
  • C3 nepritic factor (Type2)
  • Hemeturia
  • Oliguria
  • Periorbital edema
  • Hypertension
+/- + + + + + - + - - - +
  • Thick glomerular basement membrane (Tram-track appearance)
  • Mesangial proliferation and leukocyte infiltration
+ (Granular)

References

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