Glomerular Module - Urine Nephrology Now

Module Overview

This module provides comprehensive, evidence-based reviews of the major glomerular diseases encountered in nephrology practice. Each topic covers pathophysiology, diagnosis, treatment, and prognosis with clinical pearls and board-relevant high-yield content. All content reflects current guideline recommendations (KDIGO 2021/2024, ACR 2024) and recent trial evidence.

Primary Glomerulopathies

IgA Nephropathy

Four-hit pathogenesis model, risk stratification, TARPEYO/sparsentan/iptacopan, APRIL inhibitors, case-based learning, self-assessment questions. Most common primary GN worldwide.

Minimal Change Disease

Podocytopathy with reversible foot process effacement. Corticosteroid therapy (pediatric vs adult regimens), steroid-sparing agents, excellent prognosis. Most common nephrotic syndrome in children.

MPGN & C3 Glomerulopathy

2016 classification evolution (immune-complex vs complement-mediated), complement dysregulation, dense deposit disease, pegcetacoplan, post-transplant recurrence (50–80%). MGRS considerations.

Nephritic Syndrome & RPGN

Anti-GBM Disease (Goodpasture)

Linear IgG on IF (pathognomonic), pulmonary-renal syndrome, urgent triple therapy (steroids + CYC + plasmapheresis), prognosis by creatinine at diagnosis, RPGN classification. Time = nephrons.

Cryoglobulinemic GN

Type I/II/III classification, HCV-driven (80–90%), classic triad (purpura + arthralgia + GN), low C4/normal C3 hallmark, DAA revolution (>95% SVR), rituximab for severe flares.

Post-Infectious GN

PSGN vs IRGN epidemiologic shift, subepithelial "humps," low C3/normal C4, ASO/anti-DNase B, pediatric (>95% recovery) vs adult IRGN (guarded prognosis, 20–30% CKD).

Infective Endocarditis & Infection-Associated GN

Modified Duke criteria, blood culture timing (≥12h apart), serologic mimicry (ANA/RF/ANCA in IE), SLE vs IE overlap, safety-first principle (~80% mortality if immunosuppressed during IE), TEE, vertebral discitis, IgA-dominant IRGN, complement pathway differentiation, renal recovery monitoring. 7 references.

Secondary Glomerular Disease

Lupus Nephritis

ISN/RPS classification, activity/chronicity indices, serologically quiet disease, obinutuzumab vs belimumab by proteinuria threshold, voclosporin, cyclophosphamide reserve strategy, 47 references. The most comprehensive review in this module.

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