Primary glomerulonephritis; pathogenesis, clinical syndromes, pathological appearance

1. Big picture

Primary glomerulonephritis (primary GN) means immune-mediated or podocyte-mediated inflammation/injury of the glomerulus where the kidney is the main affected organ.

The examiner wants you to organize it like this:

Glomerular injury → urine pattern → clinical syndrome → biopsy pattern → likely diagnosis

The most important bedside clues are:

• Proteinuria-dominant disease → nephrotic syndrome.
• Haematuria-dominant disease → nephritic syndrome.
• Rapid creatinine rise + RBC casts → rapidly progressive glomerulonephritis, a nephrological emergency.
• Renal biopsy gives the final pathological diagnosis in most adult glomerular diseases.

KDIGO’s gl