Algorithm - Approach to the differential diagnosis of the patient presenting with overt glomerular proteinuria. CMV = Cytomegalovirus; GBM = glomerular basement membrane; GN = glomerulonephritis; HUS = hemolytic-uremic syndrome; aHUS = atypical HUS; MPGN = membranoproliferative glomerulonephritis; TTP = thrombotic thrombocytopenic purpura. Overglomerular proteinuria is arbitrarily defined as urine protein >1.0 g/ days in a collection that is documented to be a complete 24-hour collection based on its creatinine content .2>5 red blood cells/high-power field + acanthocytes or red cell/white cell casts. One or more of the following are involved: abdomen (enteritis, colitis, pancreatitis), joints (arthritis), central nervous system (stroke, seizure, cognitive impairment), heart disease, ear (unexplained effusions), extremities (ischemia, infarction), eye (inflammation of the retina, uveae, plexus, or sclera), lungs (hemoptysis, infiltrates, lymphadenopathy, pleuritic pain, pleural effusion), mouth (ulcers), nose (epistaxis), skin (alopecia, purpura, palpable purpura, maculopapular rash vesicular rash, sclerosis). In each diagnosis cluster, the diseases are listed in order of approximate incidence. Diabetic nephropathy and scleroderma are listed in 2 diagnosis clusters because nephritic urine sediment may or may not be present. Nephrocalcinosis causes nephron loss, causing secondary FSGS. Hematuria may be present.
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