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Glomerulonephritis

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Glomerulonephritis Brian S. Pavey, DO, MS Presentation Sudden onset Hematuria Hypertension Edema Acute kidney injury Broad Differential Diagnosis Asymptomatic ... – PowerPoint PPT presentation

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Title: Glomerulonephritis


1
Glomerulonephritis
  • Brian S. Pavey, DO, MS

2
Presentation
  • Sudden onset
  • Hematuria
  • Hypertension
  • Edema
  • Acute kidney injury

3
Broad Differential Diagnosis
  • Asymptomatic microscopic or gross hematuria
  • Thin basement membrane nephropathy
  • IgA nephropathy
  • Mesangioproliferative nephropathy
  • Alports syndrome
  • Acute Nephritis
  • Acute proliferative glomerulonephritis
  • Post-infectious glomerulonephritis
  • Focal or diffuse proliferative glomerulonephritis
  • IgA nephropathy
  • Lupus nephritis
  • Type I MPGN
  • Type II MPGN
  • Fibrillary glomerulonephritis
  • Rapidly Progressive glomerulonephritis
  • Pulmonary-renal vasculitic syndrome
  • Goodpasture (Anti-GBM) syndrome
  • Immune complex vasculitis
  • Lupus

4
Approaching Acute Nephritis
  • Urinalysis
  • Hematuria
  • Proteinuria
  • Urine microscopy
  • Dysmorphic RBCs, RBC casts, acanthocytes
  • Assess 24-hour proteinuria (prot/creat ratio)
  • Acute phase reactants
  • ESR, CRP,
  • Renal Ultrasound

5
(No Transcript)
6
Nephritic Workup
  • CBC
  • CMP, Phosphorus
  • ESR/CRP
  • Complement C3 and C4
  • UA with microscopic evaluation
  • Quantify proteinuria
  • Streptozyme (anti-streptolysin O)
  • Blood culture
  • ANA
  • Anti-DS DNA
  • Hepatitis B C serologies
  • ANCAs
  • Anti-GBM
  • UPEP with immunofixation
  • SPEP with immunofixation
  • Serum free light chains
  • Renal ultrasound
  • ? Chest Xray or CT chest
  • ? Echocardiogram

7
What is the Diagnosis?
8
Henoch-Schonlein Purpura
  • Tetrad of HSP
  • Palpable purpura without thrombocytopenia and
    coagulopathy
  • Arthritis/arthralgia
  • Abdominal pain
  • Renal disease (of 52 patients in a case series)
  • Microscopic hematuria in 37 patients (11 percent)
  • Gross hematuria in 12 patients (5 percent)
  • Of the 49 patients with hematuria, 28 had
    proteinuria
  • Nephrotic syndrome in 2 patients
  • Isolated proteinuria in 2 patients
  • Cause unknown, possible autoimmune
  • Supportive care, typically self-limiting

9
What is the Diagnosis?
10
Cryoglobulinemia
  • Commonly associated with Hepatitis C infection,
    can other causes
  • Can develop into rapidly progressive GN or
    chronic progressive GN
  • Treatment aimed at underlying disorder

11
What is the diagnosis?
12
Thrombotic Thrombocytopenic Purpura
  • Pentad
  • Microangiopathic hemolytic anemia
  • Thrombocytopenia, often with purpura but not
    usually severe bleeding
  • Acute Kidney Injury
  • Altered mental status
  • Fever is rare
  • Treatment
  • Plasma exchange
  • Immune suppression

13
What is the Diagnosis?
14
Systemic Lupus Erythematosis
  • Types of Lupus-related kidney damage
  • Class 1 minimal mesangial lupus nephritis
  • Class 2 mesangial proliferative lupus nephritis
  • Class 3 focal lupus nephritis
  • Class 4 diffuse lupus nephritis
  • Class 5 membranous lupus nephritis
  • Class 6 advances sclerosing lupus nephritis

15
What is the Diagnosis?
16
Infective Endocarditis
  • Four potential causes of kidney damage
  • Post-infectious immune complex-mediated GN
  • Drug induced interstitial nephritis
  • Aminoglycoside induced ATN
  • Thromboembolic
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