# Glomerular Syndromes: Pattern Before Pathology

Manage volume, blood pressure, thrombosis risk, infection risk, and medication safety while disease-specific evaluation proceeds.

![Infographic: Glomerular Syndromes: Pattern Before Pathology](https://urinenephrology.org/visual-reference/images/mastery-nephritic-nephrotic.png?v=20261003c)

## Two recognizable patterns

Nephritic disease emphasizes inflammation and hematuria; nephrotic disease emphasizes substantial protein loss and its systemic effects. Many diseases overlap these patterns.

## Recognize urgent injury

Rapidly worsening kidney function, red cell casts, pulmonary symptoms, severe hypertension, or major edema should accelerate assessment.

## Characterize the urine

Quantify protein, examine sediment, and assess the relationship between albumin loss and total protein. Pair urinary findings with serum albumin and kidney trends.

## Use complement to organize, not diagnose

Low C3 with relatively preserved C4 suggests a different pathway from reductions in both, but neither pattern proves a specific disease. Integrate infection, monoclonal studies, lupus testing, and biopsy. Normal complement does not exclude ANCA-associated or anti-GBM disease.

## Accelerate for pulmonary–renal disease

Glomerular hematuria with rapidly declining kidney function and pulmonary hemorrhage requires urgent specialist assessment, anti-GBM/ANCA testing, and coordinated biopsy/treatment planning. Do not wait for a complete outpatient serology panel before recognizing an organ-threatening presentation.

## Treat complications concurrently

Manage volume, blood pressure, thrombosis risk, infection risk, and medication safety while disease-specific evaluation proceeds.

## Source lessons

- [nephrotic nephritic comprehensive](https://urinenephrology.org/mastery/glomerular/nephrotic-nephritic-comprehensive.html)

Read alongside the full lessons; the findings and decisions shown here require the stated clinical context.