Glomerulonephritis differential diagnosis

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Differential Diagnosis

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 (Gross or 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)	Necrotizing granulomas (Nasopharynx, lungs, kidneys) Conjunctivitis Ulceration of the cornea Episcleritis Peripheral neuropathy	+/-	+	+	+	+	+	-	-	+	+ (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)