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Mrs. EB

Mrs. EB. Mesangiocapillary Glomerulonephritis. Pt Background. Mrs. EB is a 62 yo female currently experiencing end stage renal failure (ESRF) 2⁰ to Mesangiocapillary Glomerulonephritis which she was diagnosed with 16 years ago. Hx of presenting complaint. Pt presented with Pyrexia Aches

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Mrs. EB

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  1. Mrs. EB Mesangiocapillary Glomerulonephritis

  2. Pt Background • Mrs. EB is a 62 yo female currently experiencing end stage renal failure (ESRF) 2⁰ to Mesangiocapillary Glomerulonephritis which she was diagnosed with 16 years ago.

  3. Hx of presenting complaint • Pt presented with • Pyrexia • Aches • Swollen hands and feet

  4. Renal History • Change in colour/smell of urine • Haematuria • Dysuria • Change in volume and stream • Nocturia, polyurua, anuria • Fever/loin pain • Bruising/itching • Oedema • Prostatism • Poor stream, difficulty starting, dribbling

  5. Examination • General appearance • Colour, swelling, AV fistula, catheter • Hands • Leukonychia, anaemia, asterixis • Arm • BP (lying then standing) • Face • Anaemia, jaundice, uraemic fetor, skin colour • Neck • JVP, auscaltate carotid arteries

  6. Examination ctd. • Chest • Praecordium, auscultate lung bases • Abdomen • Palpate & percuss liver & spleen, kidney punch, ballot kidneys, auscultate for renal bruits, palpate and auscultate a.aorta, examine fermoral pulse & radio-femoral delay, rectal exam • Back • Vertebral tenderness, sacral oedema • Lower limbs • Oedema, inspect skin, capillary refill,

  7. Urinalysis • Specific gravity • pH • Protein • Blood • WBC • RBC • Microscopy • Casts (damage to the glom basement mem or tubules)

  8. Mx • Dx with Mesangiocapillary Glomerulonephritis by biopsy. • Did not respond to corticosteriods (as expected). • Started on diuretics and an ACE inhibitors

  9. 16 yrs later • Presented with malaise, weight increase and oedema. • Creatinine was above 500 (70-150) umol/L • Kidney function 5-10% • Corticosteroids failed again • Started on haemodialysis due to ESRF

  10. Mesangiocapillary GN • There is no proven treatment • 50% of pts develop ESRF Oxford Handbook of Clinical Medicine

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