Membranous glomerulonephritis differential diagnosis: Difference between revisions

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[Disease name] must be differentiated from [[differential dx1], [differential dx2], and [differential dx3].
[Disease name] must be differentiated from [[differential dx1], [differential dx2], and [differential dx3].


==Differentiating X from other Diseases==
==Differentiating Membranous Glomerulonephritis from Other Diseases==
*[Disease name] must be differentiated from other diseases that cause [clinical feature 1], [clinical feature 2], and [clinical feature 3], such as [differential dx1], [differential dx2], and [differential dx3].
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 microscope|light]] and [[Electron microscopy|electron microscopic]] features.  
*[Disease name] must be differentiated from [[differential dx1], [differential dx2], and [differential dx3].
The following table differentiates between various types of glomerulonephritides:<ref name="pmid17195422">{{cite journal |vauthors=Saha TC, Singh H |title=Minimal change disease: a review |journal=South. Med. J. |volume=99 |issue=11 |pages=1264–70 |date=November 2006 |pmid=17195422 |doi=10.1097/01.smj.0000243183.87381.c2 |url=}}</ref><ref name="pmid27092244">{{cite journal |vauthors=Saleem MA, Kobayashi Y |title=Cell biology and genetics of minimal change disease |journal=F1000Res |volume=5 |issue= |pages= |date=2016 |pmid=27092244 |pmc=4821284 |doi=10.12688/f1000research.7300.1 |url=}}</ref><ref name="pmid26064510">{{cite journal |vauthors=Keskar V, Jamale TE, Kulkarni MJ, Kiggal Jagadish P, Fernandes G, Hase N |title=Minimal-change disease in adolescents and adults: epidemiology and therapeutic response |journal=Clin Kidney J |volume=6 |issue=5 |pages=469–72 |date=October 2013 |pmid=26064510 |pmc=4438390 |doi=10.1093/ckj/sft063 |url=}}</ref><ref name="pmid21974967">{{cite journal |vauthors=Chugh SS, Clement LC, Macé C |title=New insights into human minimal change disease: lessons from animal models |journal=Am. J. Kidney Dis. |volume=59 |issue=2 |pages=284–92 |date=February 2012 |pmid=21974967 |pmc=3253318 |doi=10.1053/j.ajkd.2011.07.024 |url=}}</ref><ref name="pmid28242845">{{cite journal |vauthors=Rosenberg AZ, Kopp JB |title=Focal Segmental Glomerulosclerosis |journal=Clin J Am Soc Nephrol |volume=12 |issue=3 |pages=502–517 |date=March 2017 |pmid=28242845 |pmc=5338705 |doi=10.2215/CJN.05960616 |url=}}</ref><ref name="pmid25168829">{{cite journal |vauthors=Jefferson JA, Shankland SJ |title=The pathogenesis of focal segmental glomerulosclerosis |journal=Adv Chronic Kidney Dis |volume=21 |issue=5 |pages=408–16 |date=September 2014 |pmid=25168829 |pmc=4149756 |doi=10.1053/j.ackd.2014.05.009 |url=}}</ref><ref name="pmid2429634">{{cite journal |vauthors=Gephardt GN, Tubbs RR, Popowniak KL, McMahon JT |title=Focal and segmental glomerulosclerosis. Immunohistologic study of 20 renal biopsy specimens |journal=Arch. Pathol. Lab. Med. |volume=110 |issue=10 |pages=902–5 |date=October 1986 |pmid=2429634 |doi= |url=}}</ref><ref name="pmid25558821">{{cite journal |vauthors=Lai WL, Yeh TH, Chen PM, Chan CK, Chiang WC, Chen YM, Wu KD, Tsai TJ |title=Membranous nephropathy: a review on the pathogenesis, diagnosis, and treatment |journal=J. Formos. Med. Assoc. |volume=114 |issue=2 |pages=102–11 |date=February 2015 |pmid=25558821 |doi=10.1016/j.jfma.2014.11.002 |url=}}</ref><ref name="pmid10495797">{{cite journal |vauthors=Wasserstein AG |title=Membranous glomerulonephritis |journal=J. Am. Soc. Nephrol. |volume=8 |issue=4 |pages=664–74 |date=April 1997 |pmid=10495797 |doi= |url=}}</ref><ref name="pmid21949093">{{cite journal |vauthors=Suzuki H, Kiryluk K, Novak J, Moldoveanu Z, Herr AB, Renfrow MB, Wyatt RJ, Scolari F, Mestecky J, Gharavi AG, Julian BA |title=The pathophysiology of IgA nephropathy |journal=J. Am. Soc. Nephrol. |volume=22 |issue=10 |pages=1795–803 |date=October 2011 |pmid=21949093 |pmc=3892742 |doi=10.1681/ASN.2011050464 |url=}}</ref><ref name="pmid23782179">{{cite journal |vauthors=Wyatt RJ, Julian BA |title=IgA nephropathy |journal=N. Engl. J. Med. |volume=368 |issue=25 |pages=2402–14 |date=June 2013 |pmid=23782179 |doi=10.1056/NEJMra1206793 |url=}}</ref><ref name="pmid22373436">{{cite journal |vauthors=He S, Wu Z |title=Gene-based Higher Criticism methods for large-scale exonic single-nucleotide polymorphism data |journal=BMC Proc |volume=5 Suppl 9 |issue= |pages=S65 |date=November 2011 |pmid=22373436 |pmc=3287904 |doi=10.1186/1753-6561-5-S9-S65 |url=}}</ref><ref name="pmid8746284">{{cite journal |vauthors=Higgins RM, Goldsmith DJ, Connolly J, Scoble JE, Hendry BM, Ackrill P, Venning MC |title=Vasculitis and rapidly progressive glomerulonephritis in the elderly |journal=Postgrad Med J |volume=72 |issue=843 |pages=41–4 |date=January 1996 |pmid=8746284 |pmc=2398323 |doi= |url=}}</ref><ref name="pmid12631105">{{cite journal |vauthors=Jennette JC |title=Rapidly progressive crescentic glomerulonephritis |journal=Kidney Int. |volume=63 |issue=3 |pages=1164–77 |date=March 2003 |pmid=12631105 |doi=10.1046/j.1523-1755.2003.00843.x |url=}}</ref><ref name="pmid8914046">{{cite journal |vauthors=Bolton WK |title=Goodpasture's syndrome |journal=Kidney Int. |volume=50 |issue=5 |pages=1753–66 |date=November 1996 |pmid=8914046 |doi= |url=}}</ref><ref name="pmid1090223">{{cite journal |vauthors=Mathew TH, Hobbs JB, Kalowski S, Sutherland PW, Kincaid-Smith P |title=Goodpasture's syndrome: normal renal diagnostic findings |journal=Ann. Intern. Med. |volume=82 |issue=2 |pages=215–8 |date=February 1975 |pmid=1090223 |doi= |url=}}</ref><ref name="pmid18172777">{{cite journal |vauthors=Renaudineau Y, Le Meur Y |title=Renal involvement in Wegener's granulomatosis |journal=Clin Rev Allergy Immunol |volume=35 |issue=1-2 |pages=22–9 |date=October 2008 |pmid=18172777 |doi=10.1007/s12016-007-8066-6 |url=}}</ref><ref name="pmid6384024">{{cite journal |vauthors=Weiss MA, Crissman JD |title=Renal biopsy findings in Wegener's granulomatosis: segmental necrotizing glomerulonephritis with glomerular thrombosis |journal=Hum. Pathol. |volume=15 |issue=10 |pages=943–56 |date=October 1984 |pmid=6384024 |doi= |url=}}</ref><ref name="pmid16632015">{{cite journal |vauthors=Sinico RA, Di Toma L, Maggiore U, Tosoni C, Bottero P, Sabadini E, Giammarresi G, Tumiati B, Gregorini G, Pesci A, Monti S, Balestrieri G, Garini G, Vecchio F, Buzio C |title=Renal involvement in Churg-Strauss syndrome |journal=Am. J. Kidney Dis. |volume=47 |issue=5 |pages=770–9 |date=May 2006 |pmid=16632015 |doi=10.1053/j.ajkd.2006.01.026 |url=}}</ref><ref name="pmid21325353">{{cite journal |vauthors=Cartin-Ceba R, Keogh KA, Specks U, Sethi S, Fervenza FC |title=Rituximab for the treatment of Churg-Strauss syndrome with renal involvement |journal=Nephrol. Dial. Transplant. |volume=26 |issue=9 |pages=2865–71 |date=September 2011 |pmid=21325353 |pmc=3218640 |doi=10.1093/ndt/gfq852 |url=}}</ref><ref name="pmid20688249">{{cite journal |vauthors=Chung SA, Seo P |title=Microscopic polyangiitis |journal=Rheum. Dis. Clin. North Am. |volume=36 |issue=3 |pages=545–58 |date=August 2010 |pmid=20688249 |pmc=2917831 |doi=10.1016/j.rdc.2010.04.003 |url=}}</ref><ref name="pmid18524109">{{cite journal |vauthors=Pagnoux C |title=[Wegener's granulomatosis and microscopic polyangiitis] |language=French |journal=Rev Prat |volume=58 |issue=5 |pages=522–32 |date=March 2008 |pmid=18524109 |doi= |url=}}</ref><ref name="pmid19908070">{{cite journal |vauthors=Alchi B, Jayne D |title=Membranoproliferative glomerulonephritis |journal=Pediatr. Nephrol. |volume=25 |issue=8 |pages=1409–18 |date=August 2010 |pmid=19908070 |pmc=2887509 |doi=10.1007/s00467-009-1322-7 |url=}}</ref><ref name="pmid657595">{{cite journal |vauthors=Davis AE, Schneeberger EE, Grupe WE, McCluskey RT |title=Membranoproliferative glomerulonephritis (MPGN type I) and dense deposit disease (DDD) in children |journal=Clin. Nephrol. |volume=9 |issue=5 |pages=184–93 |date=May 1978 |pmid=657595 |doi= |url=}}</ref>


*As [disease name] manifests in a variety of clinical forms, differentiation must be established in accordance with the particular subtype. [Subtype name 1] must be differentiated from other diseases that cause [clinical feature 1], such as [differential dx1] and [differential dx2]. In contrast, [subtype name 2] must be differentiated from other diseases that cause [clinical feature 2], such as [differential dx3] and [differential dx4].
{| class="wikitable"
 
! rowspan="3" align="center" style="background:#4479BA; color: #FFFFFF;" + |Glomerulonephritis
===Preferred Table===
! rowspan="3" align="center" style="background:#4479BA; color: #FFFFFF;" + |Sub-entity
{|
! rowspan="3" align="center" style="background:#4479BA; color: #FFFFFF;" + |Causes and associations
|- style="background: #4479BA; color: #FFFFFF; text-align: center;"
! colspan="7" rowspan="2" align="center" style="background:#4479BA; color: #FFFFFF;" + |History and Symtoms
! rowspan="2" |Diseases
! colspan="9" align="center" style="background:#4479BA; color: #FFFFFF;" + |Laboratory Findings
! colspan="4" |History and Symptoms
|-
! colspan="4" |Physical Examination
! rowspan="2" align="center" style="background:#4479BA; color: #FFFFFF;" + |Hyperlipidemia and hypercholesterolemia
! colspan="4" |Laboratory Findings
! rowspan="2" align="center" style="background:#4479BA; color: #FFFFFF;" + |Nephrotic features
! rowspan="2" |Other Findings
! rowspan="2" align="center" style="background:#4479BA; color: #FFFFFF;" + |Nephritic features
|- style="background: #4479BA; color: #FFFFFF; text-align: center;"
! rowspan="2" align="center" style="background:#4479BA; color: #FFFFFF;" + |ANCA
!Finding
! rowspan="2" align="center" style="background:#4479BA; color: #FFFFFF;" + |Anti-glomerular basement membrane antibody (Anti-GBM antibody)
1
! rowspan="2" align="center" style="background:#4479BA; color: #FFFFFF;" + |Immune complex formation
!Finding 2
! rowspan="2" align="center" style="background:#4479BA; color: #FFFFFF;" + |Light microscope
!Finding 3
! rowspan="2" align="center" style="background:#4479BA; color: #FFFFFF;" + |Electron microscope
!Finding
! rowspan="2" align="center" style="background:#4479BA; color: #FFFFFF;" + |Immunoflourescence pattern
4
|-
!Physical Finding 1
! align="center" style="background:#4479BA; color: #FFFFFF;" + |History
!Physical Finding 2
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Pitting edema
!Physical Finding 3
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Hemeturia (pre-dominantly microscopic)
!Physical Finding 4
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Hypertension
!Lab Test 1
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Hemoptysis
!Lab Test 2
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Oliguria
!Lab Test 3
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Peri-orbital edema
!Lab Test 4
|-
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |Differential Diagnosis 1
| rowspan="3" align="center" style="background:#4479BA; color: #FFFFFF;" + |Non-proliferative
| style="background: #F5F5F5; padding: 5px;" |
![[Minimal change disease]]
| style="background: #F5F5F5; padding: 5px;" |
|
| style="background: #F5F5F5; padding: 5px;" |<nowiki>+</nowiki>
* [[Idiopathic]]
| style="background: #F5F5F5; padding: 5px;" |
* [[Protein]] [[Protein tyrosine phosphatase|tyrosine phosphatase]] receptor type O (glomerular epithelial protein 1- GLEPP1)
| style="background: #F5F5F5; padding: 5px;" |
|
| style="background: #F5F5F5; padding: 5px;" |
* Young children
| style="background: #F5F5F5; padding: 5px;" |
* Recent [[infection]] and [[immunization]]
| style="background: #F5F5F5; padding: 5px;" |
* [[Atopy]]
| style="background: #F5F5F5; padding: 5px;" |
* [[Hodgkin's lymphoma|Hodgkin lymphoma]]
| style="background: #F5F5F5; padding: 5px;" |
* [[Thrombosis]] (due to [[Urinary system|urinary]] loss of [[Antithrombin III|antithrombin-III]])
| style="background: #F5F5F5; padding: 5px;" |
|
| style="background: #F5F5F5; padding: 5px;" |
+
| style="background: #F5F5F5; padding: 5px;" |
|
-
|
-
|
-
|
+/-
|
-
|
+
|
+
|
-
|
-
|
-
|
-
|
* Normal
|
* Fusion of [[podocytes]]
|
-
|-
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |Differential Diagnosis 2
![[Focal segmental glomerulosclerosis]]
| style="background: #F5F5F5; padding: 5px;" |'''↑'''
|
| style="background: #F5F5F5; padding: 5px;" |
* Idiopathic
| style="background: #F5F5F5; padding: 5px;" |
* [[Human Immunodeficiency Virus (HIV)|HIV]]
| style="background: #F5F5F5; padding: 5px;" | -
* [[Heroine hydrochloride|Heroine]] use
| style="background: #F5F5F5; padding: 5px;" |
* [[Sickle-cell disease|Sickle cell disease]]
| style="background: #F5F5F5; padding: 5px;" |
* [[Interferon]]
| style="background: #F5F5F5; padding: 5px;" |
* Severe [[obesity]]
| style="background: #F5F5F5; padding: 5px;" |
* [[Cryoglobulinemia|Mixed cryoglobulinemia]] ([[Hepatitis C]])
| style="background: #F5F5F5; padding: 5px;" |
|
| style="background: #F5F5F5; padding: 5px;" |
* Adults
| style="background: #F5F5F5; padding: 5px;" |
|<nowiki>+</nowiki>
| style="background: #F5F5F5; padding: 5px;" |
|<nowiki>-</nowiki>
| style="background: #F5F5F5; padding: 5px;" |
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|<nowiki>+/-</nowiki>
|<nowiki>-</nowiki>
| +
| +
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|
* Focal (some [[glomeruli]]) and segmental (only part of [[glomerulus]])
|
* Effacement of [[podocytes]]
|<nowiki>-</nowiki>
|-
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |Differential Diagnosis 3
![[Membranous glomerulonephritis]]
| style="background: #F5F5F5; padding: 5px;" |
|
| style="background: #F5F5F5; padding: 5px;" |↓
* [[Idiopathic]]
| style="background: #F5F5F5; padding: 5px;" |
* [[Hepatitis B]] and [[Hepatitis C|C]]
| style="background: #F5F5F5; padding: 5px;" |
* [[Solid tumors]]
| style="background: #F5F5F5; padding: 5px;" |
* [[Systemic lupus erythematosus]]
| style="background: #F5F5F5; padding: 5px;" |
* Drugs ([[NSAIDS]], pencilamine, [[gold]], [[captopril]])
| style="background: #F5F5F5; padding: 5px;" |
|
| style="background: #F5F5F5; padding: 5px;" |
|<nowiki>+</nowiki>
| style="background: #F5F5F5; padding: 5px;" |
|<nowiki>-</nowiki>
| style="background: #F5F5F5; padding: 5px;" |
|<nowiki>-</nowiki>
| style="background: #F5F5F5; padding: 5px;" |
|<nowiki>-</nowiki>
| style="background: #F5F5F5; padding: 5px;" |
|<nowiki>+/-</nowiki>
| style="background: #F5F5F5; padding: 5px;" |
|<nowiki>-</nowiki>
| +
| +
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|<nowiki>+</nowiki>
|
* Thick [[glomerular basement membrane]]
|
* Sub-[[Epithelial cells|epithelial]] [[immune complex]] depositis with 'spike and dome' appearance
|<nowiki>-</nowiki>
|-
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |Differential Diagnosis 4
| rowspan="7" align="center" style="background:#4479BA; color: #FFFFFF;" + |Proliferative
| style="background: #F5F5F5; padding: 5px;" |
![[IgA nephropathy]]
| style="background: #F5F5F5; padding: 5px;" |
|
| style="background: #F5F5F5; padding: 5px;" |
* [[Idiopathic]]
| style="background: #F5F5F5; padding: 5px;" |
* [[Viral infections]]
| style="background: #F5F5F5; padding: 5px;" |
|
| style="background: #F5F5F5; padding: 5px;" |
* Young children
| style="background: #F5F5F5; padding: 5px;" |
* History of [[mucosal]] [[infections]] (e.g. [[gastroenteritis]]) and [[upper respiratory tract infection]]
| style="background: #F5F5F5; padding: 5px;" |
* 2-3 days after [[infection]] (synpharyngitic)
| style="background: #F5F5F5; padding: 5px;" |
|<nowiki>+/-</nowiki>
| style="background: #F5F5F5; padding: 5px;" |
|<nowiki>+</nowiki>
| style="background: #F5F5F5; padding: 5px;" |
|<nowiki>+</nowiki>
| style="background: #F5F5F5; padding: 5px;" |
|<nowiki>-</nowiki>
| style="background: #F5F5F5; padding: 5px;" |
|<nowiki>+</nowiki>
|<nowiki>+/-</nowiki>
| -
|<nowiki>-</nowiki>
|<nowiki>+</nowiki>
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
| +
|
* Crescent formation
|
* [[Mesangial cell|Mesangial]] proliferation
|<nowiki>-</nowiki>
|-
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |Differential Diagnosis 5
! rowspan="5" |[[Rapidly progressive glomerulonephritis]]
| style="background: #F5F5F5; padding: 5px;" |
|
| style="background: #F5F5F5; padding: 5px;" |
* [[Goodpasture syndrome]]
| style="background: #F5F5F5; padding: 5px;" |
|
| style="background: #F5F5F5; padding: 5px;" |
* Young adults
| style="background: #F5F5F5; padding: 5px;" |
|<nowiki>+/-</nowiki>
| style="background: #F5F5F5; padding: 5px;" |
|<nowiki>+</nowiki>
| style="background: #F5F5F5; padding: 5px;" |
|<nowiki>+</nowiki>
| style="background: #F5F5F5; padding: 5px;" |
|<nowiki>+</nowiki>
| style="background: #F5F5F5; padding: 5px;" |
|<nowiki>+</nowiki>
| style="background: #F5F5F5; padding: 5px;" |
|<nowiki>+</nowiki>
| style="background: #F5F5F5; padding: 5px;" |
| -
| style="background: #F5F5F5; padding: 5px;" |
|<nowiki>-</nowiki>
| style="background: #F5F5F5; padding: 5px;" |
|<nowiki>+</nowiki>
|}
|<nowiki>-</nowiki>
 
|<nowiki>+</nowiki>
===Use if the above table can not be made===
|<nowiki>+</nowiki>
{| style="border: 0px; font-size: 90%; margin: 3px; width: 1000px" align="center"
|
| valign="top" |
* Hypercellular and [[inflamed]] [[glomeruli]] (Crescent formation)
|+
|
! style="background: #4479BA; width: 200px;" | {{fontcolor|#FFF|Differential Diagnosis}}
*  Diffuse thickening of the [[glomerular basement membrane]] with absence of sub-[[Epithelial cells|epithelial]] and sub-[[endothelial]] deposits 
! style="background: #4479BA; width: 300px;" | {{fontcolor|#FFF|Similar Features}}
|<nowiki>+ (Linear)</nowiki>
! style="background: #4479BA; width: 300px;" | {{fontcolor|#FFF|Differentiating Features}}
|-
|-
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold; text-align:center;" |Differential 1
|
| style="padding: 5px 5px; background: #F5F5F5;" |
* [[Poststreptococcal glomerulonephritis|Post infectious glomerulonephritis]]
* On [physical exam; history; diagnostic test; imaging], [Differential 1] {has; demonstrates} [feature 1], [feature 2], [feature 3] also observed in [disease name].
|
| style="padding: 5px 5px; background: #F5F5F5;" |
* [[Streptococcal infections|Streptococcal]] [[skin]] [[infections]]  
* On [physical exam; history; diagnostic test; imaging], [Differential 1] {has; demonstrates} [feature 1], [feature 2], [feature 3] that distinguish it from [disease name].
* [[Streptococcus|Streptococcal]] [[pharyngitis]]
* 2-3 weeks after [[infection]]
|<nowiki>+/-</nowiki>
|<nowiki>+</nowiki>
|<nowiki>+</nowiki>
|<nowiki>+</nowiki>
|<nowiki>+</nowiki>
|<nowiki>+</nowiki>
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|<nowiki>+</nowiki>
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|<nowiki>+</nowiki>
|
* Hypercellular and [[inflamed]] [[glomeruli]]
|
* Sub-[[epithelial]] [[immune complex]] deposits
| + (Granular)
|-
|-
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold; text-align:center;" |Differential 2
|
| style="padding: 5px 5px; background: #F5F5F5;" |
* [[Granulomatosis with polyangiitis|Granulomatosis with polyangitis]] ([[Wegener's granulomatosis|Wegner's granulomatosis]])
* On [physical exam; history; diagnostic test; imaging], [Differential 1] {has; demonstrates} [feature 1], [feature 2], [feature 3] also observed in [disease name].
|
| style="padding: 5px 5px; background: #F5F5F5;" |
* [[Necrotizing]] [[granulomas]] ([[Nasopharynx]], [[lungs]], [[kidneys]])
* On [physical exam; history; diagnostic test; imaging], [Differential 1] {has; demonstrates} [feature 1], [feature 2], [feature 3] that distinguish it from [disease name].
* [[Conjunctivitis]]
* Ulceration of the [[cornea]]
* [[Episcleritis]]
* [[Peripheral neuropathy]]
|<nowiki>+/-</nowiki>
|<nowiki>+</nowiki>
|<nowiki>+</nowiki>
|<nowiki>+</nowiki>
|<nowiki>+</nowiki>
|<nowiki>+</nowiki>
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|<nowiki>+</nowiki>
| + ([[C-ANCA]])
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|
* Hypercellular and [[inflamed]] [[glomeruli]] (Crescent formation)
|<nowiki>-  (pauci-immune)</nowiki>
|<nowiki>+/-</nowiki>
|-
|-
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold; text-align:center;" |Differential 3
|
| style="padding: 5px 5px; background: #F5F5F5;" |
* [[Churg-Strauss syndrome|Churg Strauss syndrome]]
* On [physical exam; history; diagnostic test; imaging], [Differential 1] {has; demonstrates} [feature 1], [feature 2], [feature 3] also observed in [disease name].
|
| style="padding: 5px 5px; background: #F5F5F5;" |
* [[Necrotizing]] [[granulomas]] ([[Lungs]] and [[kidneys]])
* On [physical exam; history; diagnostic test; imaging], [Differential 1] {has; demonstrates} [feature 1], [feature 2], [feature 3] that distinguish it from [disease name].
* [[Asthma]]
* [[Peripheral neuropathy]]
|<nowiki>+/-</nowiki>
|<nowiki>+</nowiki>
|<nowiki>+</nowiki>
|<nowiki>+</nowiki>
|<nowiki>+</nowiki>
|<nowiki>+</nowiki>
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|<nowiki>+</nowiki>
|
+ ([[C-ANCA]])
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|
* Hypercellular and [[inflamed]] [[glomeruli]] (Crescent formation)
|<nowiki>- (pauci-immune)</nowiki>
|<nowiki>-</nowiki>
|-
|-
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold; text-align:center;" |Differential 4
|
| style="padding: 5px 5px; background: #F5F5F5;" |
* [[Microscopic polyangiitis]]
* On [physical exam; history; diagnostic test; imaging], [Differential 1] {has; demonstrates} [feature 1], [feature 2], [feature 3] also observed in [disease name].
|
| style="padding: 5px 5px; background: #F5F5F5;" |
* [[Necrotizing]] [[vasculitis]] (no [[granuloma]])
* On [physical exam; history; diagnostic test; imaging], [Differential 1] {has; demonstrates} [feature 1], [feature 2], [feature 3] that distinguish it from [disease name].
|<nowiki>+/-</nowiki>
|<nowiki>+</nowiki>
|<nowiki>+</nowiki>
|<nowiki>+</nowiki>
|<nowiki>+</nowiki>
|<nowiki>+</nowiki>
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
| +
|
+ ([[P-ANCA]])
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|
* Hypercellular and [[inflamed]] [[glomeruli]] (Crescent formation)
|<nowiki>- (pauci-immune)</nowiki>
|<nowiki>-</nowiki>
|-
|-
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold; text-align:center;" |Differential 5
![[Membranoproliferative glomerulonephritis]]
| style="padding: 5px 5px; background: #F5F5F5;" |
|
* On [physical exam; history; diagnostic test; imaging], [Differential 1] {has; demonstrates} [feature 1], [feature 2], [feature 3] also observed in [disease name].
* [[Idiopathic]]
| style="padding: 5px 5px; background: #F5F5F5;" |
* [[Hepatitis B]] and [[Hepatitis C|C]] (Type 1)
* On [physical exam; history; diagnostic test; imaging], [Differential 1] {has; demonstrates} [feature 1], [feature 2], [feature 3] that distinguish it from [disease name].
* C3 nepritic factor (Type2)
|
* [[Hematuria]]
* [[Oliguria]]
* [[Periorbital edema]]
* [[Hypertension]]
|<nowiki>+/-</nowiki>
|<nowiki>+</nowiki>
|<nowiki>+</nowiki>
|<nowiki>+</nowiki>
|<nowiki>+</nowiki>
|<nowiki>+</nowiki>
|<nowiki>-</nowiki>
|<nowiki>+</nowiki>
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|<nowiki>+</nowiki>
|
* Thick [[glomerular basement membrane]] (Tram-track appearance)
|
* [[Mesangial cell|Mesangial]] proliferation and [[Leukocytes|leukocyte]] infiltration
|<nowiki>+ (Granular)</nowiki>
|}
|}


==References==
==References==

Revision as of 15:33, 2 May 2018

Membranous glomerulonephritis Microchapters

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief:

Overview

[Disease name] must be differentiated from other diseases that cause [clinical feature 1], [clinical feature 2], and [clinical feature 3], such as [differential dx1], [differential dx2], and [differential dx3].

OR

[Disease name] must be differentiated from [[differential dx1], [differential dx2], and [differential dx3].

Differentiating Membranous Glomerulonephritis from Other Diseases

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. The following table differentiates between various types of glomerulonephritides:[1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24]

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

+

-

-

-

+/-

-

+

+

-

-

-

-

  • Normal

-

Focal segmental glomerulosclerosis
  • Adults
 + - - - +/- - + + - - - - -
Membranous glomerulonephritis + - - - +/- - + + - - - + -
Proliferative IgA nephropathy +/- + + - + +/- - - + - - +
  • Crescent formation
 -
Rapidly progressive glomerulonephritis
  • Young adults
 +/- + + + + + - - + - + + + (Linear)
+/- + + + + + - - + - - + + (Granular)
+/- + + + + + - - + + (C-ANCA) - - - (pauci-immune) +/-
+/- + + + + + - - +

+ (C-ANCA)

- - - (pauci-immune) -
+/- + + + + + - - +

+ (P-ANCA)

- - - (pauci-immune) -
Membranoproliferative glomerulonephritis +/- + + + + + - + - - - + + (Granular)


References

  1. ↑ Saha TC, Singh H (November 2006). "Minimal change disease: a review". South. Med. J. 99 (11): 1264–70. doi:10.1097/01.smj.0000243183.87381.c2. PMID 17195422.
  2. ↑ Saleem MA, Kobayashi Y (2016). "Cell biology and genetics of minimal change disease". F1000Res. 5. doi:10.12688/f1000research.7300.1. PMC 4821284. PMID 27092244.
  3. ↑ Keskar V, Jamale TE, Kulkarni MJ, Kiggal Jagadish P, Fernandes G, Hase N (October 2013). "Minimal-change disease in adolescents and adults: epidemiology and therapeutic response". Clin Kidney J. 6 (5): 469–72. doi:10.1093/ckj/sft063. PMC 4438390. PMID 26064510.
  4. ↑ Chugh SS, Clement LC, Macé C (February 2012). "New insights into human minimal change disease: lessons from animal models". Am. J. Kidney Dis. 59 (2): 284–92. doi:10.1053/j.ajkd.2011.07.024. PMC 3253318. PMID 21974967.
  5. ↑ Rosenberg AZ, Kopp JB (March 2017). "Focal Segmental Glomerulosclerosis". Clin J Am Soc Nephrol. 12 (3): 502–517. doi:10.2215/CJN.05960616. PMC 5338705. PMID 28242845.
  6. ↑ Jefferson JA, Shankland SJ (September 2014). "The pathogenesis of focal segmental glomerulosclerosis". Adv Chronic Kidney Dis. 21 (5): 408–16. doi:10.1053/j.ackd.2014.05.009. PMC 4149756. PMID 25168829.
  7. ↑ Gephardt GN, Tubbs RR, Popowniak KL, McMahon JT (October 1986). "Focal and segmental glomerulosclerosis. Immunohistologic study of 20 renal biopsy specimens". Arch. Pathol. Lab. Med. 110 (10): 902–5. PMID 2429634.
  8. ↑ Lai WL, Yeh TH, Chen PM, Chan CK, Chiang WC, Chen YM, Wu KD, Tsai TJ (February 2015). "Membranous nephropathy: a review on the pathogenesis, diagnosis, and treatment". J. Formos. Med. Assoc. 114 (2): 102–11. doi:10.1016/j.jfma.2014.11.002. PMID 25558821.
  9. ↑ Wasserstein AG (April 1997). "Membranous glomerulonephritis". J. Am. Soc. Nephrol. 8 (4): 664–74. PMID 10495797.
  10. ↑ Suzuki H, Kiryluk K, Novak J, Moldoveanu Z, Herr AB, Renfrow MB, Wyatt RJ, Scolari F, Mestecky J, Gharavi AG, Julian BA (October 2011). "The pathophysiology of IgA nephropathy". J. Am. Soc. Nephrol. 22 (10): 1795–803. doi:10.1681/ASN.2011050464. PMC 3892742. PMID 21949093.
  11. ↑ Wyatt RJ, Julian BA (June 2013). "IgA nephropathy". N. Engl. J. Med. 368 (25): 2402–14. doi:10.1056/NEJMra1206793. PMID 23782179.
  12. ↑ He S, Wu Z (November 2011). "Gene-based Higher Criticism methods for large-scale exonic single-nucleotide polymorphism data". BMC Proc. 5 Suppl 9: S65. doi:10.1186/1753-6561-5-S9-S65. PMC 3287904. PMID 22373436.
  13. ↑ Higgins RM, Goldsmith DJ, Connolly J, Scoble JE, Hendry BM, Ackrill P, Venning MC (January 1996). "Vasculitis and rapidly progressive glomerulonephritis in the elderly". Postgrad Med J. 72 (843): 41–4. PMC 2398323. PMID 8746284.
  14. ↑ Jennette JC (March 2003). "Rapidly progressive crescentic glomerulonephritis". Kidney Int. 63 (3): 1164–77. doi:10.1046/j.1523-1755.2003.00843.x. PMID 12631105.
  15. ↑ Bolton WK (November 1996). "Goodpasture's syndrome". Kidney Int. 50 (5): 1753–66. PMID 8914046.
  16. ↑ Mathew TH, Hobbs JB, Kalowski S, Sutherland PW, Kincaid-Smith P (February 1975). "Goodpasture's syndrome: normal renal diagnostic findings". Ann. Intern. Med. 82 (2): 215–8. PMID 1090223.
  17. ↑ Renaudineau Y, Le Meur Y (October 2008). "Renal involvement in Wegener's granulomatosis". Clin Rev Allergy Immunol. 35 (1–2): 22–9. doi:10.1007/s12016-007-8066-6. PMID 18172777.
  18. ↑ Weiss MA, Crissman JD (October 1984). "Renal biopsy findings in Wegener's granulomatosis: segmental necrotizing glomerulonephritis with glomerular thrombosis". Hum. Pathol. 15 (10): 943–56. PMID 6384024.
  19. ↑ Sinico RA, Di Toma L, Maggiore U, Tosoni C, Bottero P, Sabadini E, Giammarresi G, Tumiati B, Gregorini G, Pesci A, Monti S, Balestrieri G, Garini G, Vecchio F, Buzio C (May 2006). "Renal involvement in Churg-Strauss syndrome". Am. J. Kidney Dis. 47 (5): 770–9. doi:10.1053/j.ajkd.2006.01.026. PMID 16632015.
  20. ↑ Cartin-Ceba R, Keogh KA, Specks U, Sethi S, Fervenza FC (September 2011). "Rituximab for the treatment of Churg-Strauss syndrome with renal involvement". Nephrol. Dial. Transplant. 26 (9): 2865–71. doi:10.1093/ndt/gfq852. PMC 3218640. PMID 21325353.
  21. ↑ Chung SA, Seo P (August 2010). "Microscopic polyangiitis". Rheum. Dis. Clin. North Am. 36 (3): 545–58. doi:10.1016/j.rdc.2010.04.003. PMC 2917831. PMID 20688249.
  22. ↑ Pagnoux C (March 2008). "[Wegener's granulomatosis and microscopic polyangiitis]". Rev Prat (in French). 58 (5): 522–32. PMID 18524109.
  23. ↑ Alchi B, Jayne D (August 2010). "Membranoproliferative glomerulonephritis". Pediatr. Nephrol. 25 (8): 1409–18. doi:10.1007/s00467-009-1322-7. PMC 2887509. PMID 19908070.
  24. ↑ Davis AE, Schneeberger EE, Grupe WE, McCluskey RT (May 1978). "Membranoproliferative glomerulonephritis (MPGN type I) and dense deposit disease (DDD) in children". Clin. Nephrol. 9 (5): 184–93. PMID 657595.

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