Wallach's Interpretation of Diagnostic Tests: Pathways to Arriving at a Clinical Diagnosis (527 page)

   Primary (idiopathic): commonly presents with nephrotic syndrome and accounts for approximately 80% of FSGS cases

   Secondary: due to diseases (e.g., vasculitis, SLE), infections (e.g., HIV, hepatitis B), drugs, toxins, malignancies, or genetic abnormalities (familial). Patients present with slowly progressing renal insufficiency over time.

   Laboratory Findings

   Marked proteinuria; nephrotic range (>3.5 g/day) in primary FSGS and nonnephrotic in secondary FSGS.

   Hypoalbuminemia (more common in primary FSGS).

   Hypercholesterolemia and peripheral edema can occur.

   Hematuria, microscopic and macroscopic.

   Serum level of soluble urokinase receptor is elevated.

   Histologic findings are used to confirm the diagnosis.

Suggested Reading

D’Agati VD, Kaskel FJ, Falk RJ. Focal segmental glomerulosclerosis.
N Engl J Med.
2011;365(25): 2398–2411.

GLOMERULONEPHRITIS

   Definition and Classification

   Glomerulonephritis (GN) is a renal disease characterized by inflammation of the glomeruli and hematuria. It can be acute or chronic and is often associated with decreased GFR, proteinuria, edema, hypertension, and sometimes oliguria.

   Acute GN is defined as the sudden onset of hematuria, proteinuria, and RBC casts.

   Chronic GN can develop over years and, in a subset of patients, can ultimately lead to renal failure.