Glomerulonephritis: Nephritic and Nephrotic Patterns

Key points

• • Glomerulonephritis is damage to the glomeruli, the kidney's tiny filters, and it commonly shows one of two broad patterns, nephritic or nephrotic, though not every case fits neatly.
• • The nephritic pattern is one of inflammation: blood (often with red-cell casts) and some protein leak into the urine, with a reduced urine output and a raised blood pressure.
• • The nephrotic pattern is one of a very leaky filter: heavy protein loss in the urine, a low blood albumin, widespread oedema and a high blood cholesterol.
• • Post-streptococcal glomerulonephritis is a classic nephritic disease appearing a week or two after a throat or skin infection, driven by immune complexes.
• • Minimal change disease is a common nephrotic cause in children, so named because the glomeruli look almost normal under the ordinary microscope.
• • Many types are driven by immune complexes or antibodies, and the exact type is told apart by the pattern of damage and deposits seen on biopsy.