C4 glomerulopathy differential diagnosis

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Ali Poyan Mehr, M.D. [2]; Associate Editor(s)-in-Chief: Olufunmilola Olubukola M.D.[3]

Overview

C4 glomerulopathy must be differentiated from other diseases that cause proteinuria, hematuria, and peripheral edema, such as IgA nephropathy, membranous nephropathy, focal segmental glomerulus /minimal change disease, membranoproliferative glomerulonephritis, and lupus nephritis.

Differential Diagnosis

On the basis of proteinuria, hematuria, C4 dense deposition, and edema, C4 glomerulopathy must be differentiated from IgA nephropathy, lupus nephritis, membranous nephropathy, membranoproliferative glomerulonephritis, focal Segmental Glomerulus /minimal change disease.

Disease	History and Physical Examination					Diagnostic approach
	Proteinuria	Hematuria	Peripheral edema	Hypertension	Weight gain	C4 dense deposition in the glomerulus	Complement pathway	Gold standard test
IgA Nephropathy	+	+	+	+	+	Mesengial	-	Renal biopsy
Membranous Nephropathy	+	-	+	-	+	Glomerular capillary wall	-	Renal biopsy
Focal Segmental Glomerulus /Minimal Change Disease	+	+	+	-	+	No Cd4 deposits	+	Renal biopsy
Membranoproliferative glomerulonephritis	+	-	+	+	+	Along capillary walls	-	Renal biopsy
Lupus Nephritis	-	+	+	+	+	Mesangium and capillary wall	+	Renal biopsy