C4 glomerulopathy differential diagnosis

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Ali Poyan Mehr, M.D. [2]; Associate Editor(s)-in-Chief: Olufunmilola Olubukola M.D.[3]

Differential Diagnosis

On the basis of proteinuria, hematuria, C4 dense deposition, and edema, C4 glomerulopathy must be differentiated from IgA nephropathy, Lupus nephritis, Membranous nephropathy, Membranoproliferative glomerulonephritis, Focal Segmental Glomerulus /Minimal Change Disease.

Disease	History and Physical Examination					Diagnostic approach
	Proteinuria	Hematuria	Peripheral edema	Hypertension	Weight gain	C4 dense deposition in the glomerulus	Complement pathway	Gold standard test
IgA Nephropathy	+	+	+	+	+	Mesengial	-	Renal biopsy
Membranous Nephropathy	+	-	+	-	+	Glomerular capillary wall	-	Renal biopsy
Focal Segmental Glomerulus /Minimal Change Disease	+	+	+	-	+	No Cd4 deposits	+	Renal biopsy
Membranoproliferative glomerulonephritis	+	-	+	+	+	Along capillary walls	-	Renal biopsy
Lupus Nephritis	-	+	+	+	+	Mesangium and capillary wall	+	Renal biopsy