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Glomerulonephritis

Glomerulonephritis

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Glomerulonephritis

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  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 • Alport’s 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 • Wegener’s granulomatosis • ANCA Vasculitis • Microscopic Polyangiitis • Wegener’s granulomatosis • Churg-Strauss syndrome

  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. 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 • ANCA’s • Anti-GBM • UPEP with immunofixation • SPEP with immunofixation • Serum free light chains • Renal ultrasound • ? Chest Xray or CT chest • ? Echocardiogram

  6. What is the Diagnosis?

  7. 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

  8. What is the Diagnosis?

  9. 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

  10. What is the diagnosis?

  11. 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

  12. What is the Diagnosis?

  13. 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

  14. What is the Diagnosis?

  15. Infective Endocarditis • Four potential causes of kidney damage • Post-infectious immune complex-mediated GN • Drug induced interstitial nephritis • Aminoglycoside induced ATN • Thromboembolic