Glomerular Diseases

I.      Program Content

       A. Trainees should acquire a general understanding of the following:

 1.  Structure and function of the normal glomerulus and how alteration
      of these leads to the cardinal features of glomerular injury
      (proteinuria and reduced GFR);

2.  The principle immunologic mechanisms causing human glomerular
     diseases and the features that distinguish them by immuno-
     fluorescence and electron microscopy;

3.  The fundamental features of the normal immune response and an
     awareness of current concepts of autoimmunity and the factors that
     may be responsible for and mediate immunologic glomerular injury.

     B. Trainees should be familiar with and develop an in-depth knowledge of:

1.  The causes, clinical decision making, and treatment of common and
     uncommon causes of hematuria and proteinuria.

2.   Etiology and clinical findings of glomerular syndromes including
      nephrosis, nephritis, rapidly progressive glomerulonephritis
      manifesting as renal-limited processes or associated with systemic
      disease.

     C.   Trainees should develop an in-depth knowledge of idiopathic glomerular
           diseases with respect pathology, clinical features, and response to treatment
           of:

1.  Minimal change nephropathy presenting in adolescents and adults,
    especially the response to corticosteroid treatment, the development
    of acute renal failure in adults, and the association with malignant
    tumors.

2.  Membranoproliferative glomerulonephritis, including type I, II and
     III.  The clinical and pathological features of this disorder with the
     association with hepatitis C and cryoglobulinemia.

3.  Focal segmental glomerulosclerosis including its various patho-
     logical and clinical syndromes and the association with conditions
     of reduced renal mass.  The demographics, clinical course, and
     outcome of the clinicopathologic syndromes of “primary” focal
     sclerosis, inducing collapsing FSGS, glomerular tip lesion, and
     perihilar FSGS.

4.   Membranous nephropathy including the clinical, pathological, and
     diagnostic features of both idiopathic membranous nephropathy and
     secondary membranous disease.  In-depth knowledge of the
     controversies regarding treatment of this disease.

5.   IgA nephropathy, especially its clinical course, natural history, and
      prognostic markers.

6.   Post-infectious glomerulopathies including bacterial, viral, parasitic,
     rickettsial, and fungal infections.  The epidemiology, clinical course,
     and response to therapy, especially with respect to HIV infections.

     D.  Trainees should develop an in-depth knowledge of glomerular diseases
           associated with systemic disease with respect to pathology, clinical and
           serological features, and response to treatment of:

1.   Necrotizing and crescentic glomerulonephritis

a.  Anti-glomerular basement membrane disease

b.  Immune complex diseases including lupus nephritis,
    postinfectious glomerulonephritis and Henoch-
    Scholein purpura.

c.  Pauci-immune glomerulonephritis and small vessel
     vasculitis.

2.   Renal manifestations of other rheumatic disorders including
     systemic sclerosis, Sjogren’s syndrome, mixed connective tissue
     disease, rheumatoid arthritis, Bechet’s syndrome, relapsing
     polychondritis, and familial Mediterranean fever.

3.   Renal disease in the dysproteinemias including multiple myeloma,
      amyloidosis, fibrillary glomerulopathy/immunotactoid glomerulo-
     pathy and mixed cryoglobulinemia

II.   Patient Care Experience

       A. Trainees should be familiar with and have experience in:

 1.  The diagnosis and management of patients with isolated proteinuria,
      hematuria, nephrotic syndrome and acute glomerulonephritis.

 2. The serological evaluations of glomerulonephritis, including the
     diagnostic value and limitations of anti-GBM, ANCA, antinuclear
     and anti-microbial antibodies, hypocomplementemia and
     cryoglobulinemia.

 3.  The indications for and complications of renal biopsy, as well as
      the morphological and immunohistological features of the major
     glomerular diseases.

 4.  The treatment of patients with nephrotic syndrome and acute
     glomerulonephritis, both renal limited and secondary to systemic
     diseases, including the indications, complications and value of
     various immunosuppressive protocols.