Diagnostic approach to glomerular diseases: integrating clinical, laboratory, and histopathological assessments

Glomerular diseases are a significant contributor to chronic kidney disease globally, accounting for up to 30% of end-stage kidney disease cases. Diagnostic accuracy is crucial for appropriate management but remains challenging, especially in low-resource settings.

Our paper addresses the diagnostic approach to glomerular diseases by integrating clinical evaluation, laboratory findings, imaging techniques, and histopathological assessments. It also highlights regional disparities and systemic barriers affecting diagnostic capacity.

We conducted a narrative review of published literature, synthesizing data from peer-reviewed articles, international registries, and survey reports to explore current diagnostic approaches to glomerular diseases. We searched databases, including PubMed, Scopus, and Google Scholar, for relevant studies published between January 2020 and December 2024.

Biopsy access was markedly limited in Africa, with only 49.7% of respondents able to perform biopsies in more than 10% of indicated cases, compared to 95.7% in Asia. Immunofluorescence and electron microscopy were unavailable or underutilized in many centers, especially in Africa. Serological testing for autoimmune glomerulopathies and the availability of key immunosuppressive therapies were also significantly constrained. These limitations frequently led to empiric treatment without a definitive diagnosis, raising concerns about mismanagement and healthcare inequities.

A multidisciplinary diagnostic approach remains essential for managing glomerular diseases. However, significant disparities in access to biopsy, nephropathology, and serological testing hamper optimal care in many regions. Investment in diagnostic infrastructure, clinician training, and health policy reforms are critical for improving global kidney health outcomes.