Merck Manual

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Overview of Glomerular Disorders

By

Frank O'Brien

, MD, Washington University in St. Louis

Last full review/revision Jul 2021| Content last modified Sep 2022
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Topic Resources

Glomerular disorders are classified based on urine changes as those that manifest predominantly with

  • Nephrotic-range proteinuria and nephrotic urine sediment (fatty casts, oval fat bodies, but few cells or cellular casts)

  • Hematuria, usually in combination with proteinuria (which may be in the nephrotic range); the red blood cells (RBCs) are usually dysmorphic and often there are RBC or mixed cellular casts (nephritic urine sediment)

The pathophysiology of nephritic and nephrotic disorders differs substantially, but their clinical overlap is considerable—eg, several disorders may manifest with the same clinical picture—and the presence of hematuria or proteinuria does not itself predict response to treatment or prognosis.

Disorders tend to manifest at different ages (see table Glomerular Disorders by Age and Manifestations Glomerular Disorders by Age and Manifestations Glomerular Disorders by Age and Manifestations ), although there is much overlap. The disorders may be

Table

Diagnosis

  • Serum creatinine level and urinalysis

A glomerular disorder is usually suspected when screening or diagnostic testing reveals an elevated serum creatinine level and abnormal urinalysis (hematuria with or without casts, proteinuria, or both). Approach to the patient involves distinguishing predominant-nephritic from predominant-nephrotic features and identifying likely causes by patient age, accompanying illness (see table Glomerular Disorders by Age and Presentation Glomerular Disorders by Age and Manifestations Glomerular Disorders by Age and Manifestations and table Causes of Nephrotic Syndrome Causes of Nephrotic Syndrome Causes of Nephrotic Syndrome ), and other elements of the history (eg, time course, systemic manifestations, family history).

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