Patterns of Glomerular Injury: Histopathological Classification and Clinical Correlation

Abstract

Glomerular diseases represent a diverse group of conditions that significantly contribute to chronic kidney disease (CKD) and end-stage renal disease (ESRD) worldwide. Understanding the histopathological patterns of glomerular injury is essential for accurate diagnosis, prognosis, and targeted therapy. This comprehensive review explores the morphologic, immunopathologic, and clinical characteristics of major glomerular disorders, including minimal change disease, focal segmental glomerulosclerosis, membranous nephropathy, immunoglobulin A nephropathy, lupus nephritis, and others. Histological classification is integrated with clinical syndromes, such as nephrotic and nephritic presentations, emphasizing the role of light microscopy, immunofluorescence, and electron microscopy in renal biopsy interpretation. Recent advances in molecular diagnostics, digital pathology, and artificial intelligence are also discussed, highlighting their transformative impact on precision nephrology. Through a multidisciplinary lens, this review underscores the prognostic and therapeutic implications of distinct histologic patterns and advocates for the continued evolution of clinicopathologic correlation in glomerular disease management.