3Urinalysis Urine is dark. Specific gravity is greater than 1020 osm. Proteinuria is observed.HaematuriaRBCs and red cell casts are present on microscopy(Perform FBE to check for anaemia)LeukocytesCreatinine level increased
4Asymptomatic urinary abnormalities Isolated proteinuria without haemturiaMay be early sign of glomerular lesion- i.e. membranous GN, IgA nephropathy, diabetic nephropathy or amyloidosisHaematuria with/without sub-nephrotic range proteinuriaSLE, Henoch-Schonlein purpura, post-infectious GN
5Blood FBE ESR, CRP for inflammation U + E’s LFT’s Serum albumin (low in nephrotic syndrome)Glucose- to exclude diabetesSerum complement (low in SLE)Auto-antibodies: serum immunoglobulins, ANCA (Wegener’s granulomatosus, anti-ss-DNA (SLE)
6Imaging Chest radiography needed in patients with a cough, with or without haemoptysis (ie, Wegener granulomatosis, Goodpasture syndrome, pulmonary congestion).Abdominal CT is needed if visceral abscesses are suspected; also look for chest abscesses.EchoFor pts with new cardiac murmur or a positive blood culturerules out endocarditis or a pericardial effusion.Renal US:to evaluate kidney size as well as to determine the extent of fibrosis.A kidney size of less than 9 cm is suggestive of extensive scarring and a low likelihood of reversibilityCT scan of the head for patient with malignant hypertension or altered mental status.
7Biopsy Candidates for biopsy: individual or family history of renal disease, atypical presentation:massive proteinurianephrotic syndromerapid rise in creatinine level without resolution.
8Post-strep GNBiopsy shows diffuse, florid, acute inflamm at the glomerulusNo necrosis, but occaisonal crescentsNeutrophils and deposition of IgG and complementLight microscopy of biopsy sample shows acute inflammation of glomerulus with neutrophils