Objective: To explore the value of 24-hour urinary protein quantification and urinary sediment red blood cell morphology analysis in the differential diagnosis of common pathological types of primary glomerular disease (PGD). Methods: A total of 120 patients diagnosed with PGD via renal biopsy at our hospital from June 2024 to December 2024 were selected as the study subjects. Based on pathological results, they were divided into three groups: minimal change disease (MCD) group (40 cases), IgA nephropathy (IgAN) group (40 cases), and membranous nephropathy (MN) group (40 cases). All patients underwent 24-hour urinary protein quantification and microscopic examination of urinary sediment to analyze red blood cell morphology (percentage of deformed red blood cells). Differences in the above indicators among the three groups were compared, and their diagnostic efficacy for PGD classification was evaluated. Spearman correlation analysis was employed to evaluate the relationship between urinary protein quantification and the percentage of abnormal red blood cells, and to assess their diagnostic performance in PGD typing.Results: Statistically significant differences were observed in 24-hour urinary protein quantification and the percentage of deformed red blood cells among the three groups (P<0.05). The 24-hour urinary protein quantification in the MN group was significantly higher than that in the MCD and IgAN groups (P<0.05). The percentage of deformed red blood cells in the IgAN group was significantly higher than that in the MN and MCD groups (P<0.05). Spearman correlation analysis revealed a weak positive correlation between urinary protein quantification and the percentage of deformed red blood cells in the overall sample (r = 0.312, P < 0.01), with a moderate positive correlation observed in the MN group (r = 0.521, P < 0.01).Conclusion: 24-hour urinary protein quantification and urinary sediment red blood cell morphology analysis are important non-invasive indicators for differentiating various types of PGD. The combination of these two methods provides a strong basis for clinical preliminary determination of pathological types, guiding treatment, and assessing prognosis.