Glomerulonephritis Brian S. Pavey, DO, MS

Presentation Sudden onset – Hematuria – Hypertension – Edema – Acute kidney injury

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

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

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

What is the Diagnosis?

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

What is the Diagnosis?

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

What is the diagnosis?

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

What is the Diagnosis?

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

What is the Diagnosis?

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