Location via proxy:   [ UP ]  
[Report a bug]   [Manage cookies]                
Scribd Logo
Upload

Welcome to Scribd!

  • 314 views

    Glomerulonephritis

    Uploaded by

    maleskun
    Glomerulonephritis refers to kidney damage involving the glomeruli and can be caused by several factors. A systematic approach should be used to diagnose the underlying cause. First, tests like a urinalysis and ultrasound are used to determine if the kidney damage is due to glomerular issues or other causes like tubular or vascular problems. Next, the urinalysis indicates whether it is a glomerulonephritis pattern with blood and protein in the urine or a nephrotic syndrome pattern with only heavy protein. Finally, complement levels in the blood are checked, as normal or low levels provide clues about systemic versus isolated kidney diseases and narrow the possible causes.

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as PDF, TXT or read online from Scribd

    Glomerulonephritis

    Uploaded by

    maleskun
    314 views1 page
    Glomerulonephritis refers to kidney damage involving the glomeruli and can be caused by several factors. A systematic approach should be used to diagnose the underlying cause. First, tests like a urinalysis and ultrasound are used to determine if the kidney damage is due to glomerular issues or other causes like tubular or vascular problems. Next, the urinalysis indicates whether it is a glomerulonephritis pattern with blood and protein in the urine or a nephrotic syndrome pattern with only heavy protein. Finally, complement levels in the blood are checked, as normal or low levels provide clues about systemic versus isolated kidney diseases and narrow the possible causes.

    Original Title

    glomerulonephritis

    Copyright

    © Attribution Non-Commercial (BY-NC)

    Available Formats

    PDF, TXT or read online from Scribd

    Did you find this document useful?

    Is this content inappropriate?

    Glomerulonephritis refers to kidney damage involving the glomeruli and can be caused by several factors. A systematic approach should be used to diagnose the underlying cause. First, tests like a urinalysis and ultrasound are used to determine if the kidney damage is due to glomerular issues or other causes like tubular or vascular problems. Next, the urinalysis indicates whether it is a glomerulonephritis pattern with blood and protein in the urine or a nephrotic syndrome pattern with only heavy protein. Finally, complement levels in the blood are checked, as normal or low levels provide clues about systemic versus isolated kidney diseases and narrow the possible causes.

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    314 views1 page

    Glomerulonephritis

    Uploaded by

    maleskun
    Glomerulonephritis refers to kidney damage involving the glomeruli and can be caused by several factors. A systematic approach should be used to diagnose the underlying cause. First, tests like a urinalysis and ultrasound are used to determine if the kidney damage is due to glomerular issues or other causes like tubular or vascular problems. Next, the urinalysis indicates whether it is a glomerulonephritis pattern with blood and protein in the urine or a nephrotic syndrome pattern with only heavy protein. Finally, complement levels in the blood are checked, as normal or low levels provide clues about systemic versus isolated kidney diseases and narrow the possible causes.

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    You are on page 1of 1

    SJS July-03

    GLOMERULONEPHRITIS FOR DUMMIES


    Madaio MP, Harrington JT. The diagnosis of glomerular diseases. Arch Intern Med. 2001 Jan 8;161(1):25-34.
    Hricik DE, Chung-Park M, Sedor JR. Glomerulonephritis. N Engl J Med. 1998 Sep 24;339(13):888-99.

    Take home points:


    1. Don’t freak out when you have a patient with possible glomerulonephritis – the differential diagnosis can
    be straightforward if you use a systematic approach.
    2. The ddx of intrinsic renal disease is: glomerular, tubular, interstitial, or vascular
    3. Glomerulonephritis presents with an active sediment (RBC, protein) and nephrotic syndrome presents
    with a bland sediment (heavy protein, otherwise negative U/A).
    4. The serum complements is the next step in diagnosing the cause of glomerulonephritis.

    Step 1: Determine the broad cause of the acute or progressive renal failure
    • Pre-renal, intrinsic renal, or post-renal
    • FENa (if oliguric – to differentiate pre-renal from ATN), U/A (to look for an active sidement),
    and renal ultrasound (to rule out obstruction) can be helpful
    • If intrinsic renal, then your differential diagnosis is:
    − Glomeruli (e.g. glomerulonephritis or nephrotic syndrome or both)
    − Tubules (e.g. ATN)
    − Interstitium (e.g. acute interstitial nephritis (AIN))
    − Vessels (e.g. atheroembolic renal disease, PAN)

    Step 2: If you’ve determined it’s a glomerular cause of renal failure, differentiate a glomerulonephritis (GN) pattern from a
    nephrotic syndrome pattern
    • At this step, you must get a urinalysis, renal ultrasound, 24 hour urine protein and creatinine,
    spot urine protein and creatinine (for protein:creatinine ratio)
    • Glomerulonephritis – look for active sediment (U/A with protein and RBCs, dysmorphic RBCs,
    and/or RBC casts), 300 mg - 3.5 g/day proteinuria, HTN, edema
    • Nephrotic syndrome – look for anasarca, heavy proteinuria (more than 3.5 g/day), and a bland
    sediment on U/A (no RBCs). Patients with true nephrotic syndrome (and not just heavy
    proteinuria) will have hyperlipidemia, lipiduria, hypoalbuminemia and a hypercoagulable state
    (seen most often in membranous nephropathy).
    • Membranoproliferative glomerulonephritis (MPGN) can present as nephrotic syndrome,
    glomerulonephritis or both.

    Step 3: Use the serum complement levels to look help differentiate causes of GN.
    • Normal serum complement levels indicate that the production of complement is keeping up with
    consumption (normal complements doesn’t mean that complement is not involved in the
    underlying disease process).
    • Once you have the complement levels back, differentiate the GN further by looking for systemic
    diseases vs. isolated renal diseases.

    Low complement GN:


    • Systemic: SLE, endocarditis, cryoglobulinemia, shunt nephritis
    • Isolated renal: post-infectious GN, MPGN

    Normal complement GN:


    • Systemic: HSP, ANCA-associted (Wegener’s, PAN), Goodpasture’s syndrome, hypersensitivity vasculitis
    • Isolated renal: IgA nephropathy, anti-GBM disease, RPGN

    You might also like