Glomerulonephritis: Difference between revisions
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*History | *History | ||
**Recent URI or skin infection (strep) | **Recent URI or skin infection (strep) | ||
**[[Rash]], arthralgia (HSP, SLE) | **[[Rash]], [[arthralgia]] (HSP, SLE) | ||
**[[Fever]], [[vomiting]], [[diarrhea]] (HUS) | **[[Fever]], [[vomiting]], [[diarrhea]] (HUS) | ||
*Often | *Often associated with hypertension | ||
*[[Hematuria]], [[proteinuria]], RBC casts | *[[Hematuria]], [[proteinuria]], RBC casts | ||
Revision as of 08:29, 13 July 2016
Background
- Characterized by hematuria and proteinuria
Causes of Glomerulonephritis
- Poststreptococcal glomerulonephritis
- Hemolytic-uremic syndrome
- Henoch-Schonlein purpura
- IgA nephropathy
- Lupus nephritis
- Alport syndrome
- Goodpasture syndrome
- Paraneoplastic
Clincal Presentation
- History
- Recent URI or skin infection (strep)
- Rash, arthralgia (HSP, SLE)
- Fever, vomiting, diarrhea (HUS)
- Often associated with hypertension
- Hematuria, proteinuria, RBC casts
Differential Diagnosis
Hematuria
Sources of hematuria.
- Urologic (lower tract)
- Any location
- Iatrogenic/postprocedure
- GU trauma
- Infection
- Kidney stone
- Erosion or mechanical obstruction by tumor
- Ureter(s)
- Dilatation of stricture
- Bladder
- Transitional cell carcinoma
- Vascular lesions or malformations
- Chemical or radiation cystitis
- Prostate
- Benign prostatic hypertrophy
- Prostatitis
- Urethra
- Stricture
- Diverticulosis
- Foreign body
- Endometriosis (cyclic hematuria with menstrual pain)
- Any location
- Renal (upper tract)
- Glomerular
- Glomerulonephritis
- IgA nephropathy (Berger disease)
- Lupus nephritis
- Hereditary nephritis (Alport syndrome)
- Toxemia of pregnancy
- Serum sickness
- Erythema multiforme
- Nonglomerular
- Interstitial nephritis
- Pyelonephritis
- Papillary necrosis: sickle cell disease, diabetes, NSAID use
- Vascular: arteriovenous malformations, emboli, aortocaval fistula
- Malignancy
- Polycystic kidney disease
- Medullary sponge disease
- Tuberculosis
- Renal trauma
- Glomerular
- Hematologic
- Primary coagulopathy (e.g., hemophilia)
- Pharmacologic anticoagulation
- Sickle cell disease
- Myoglobinuria - positive blood, no RBCs: rhabdomyolysis
- Hemoglobinuria - positive blood, no RBCs
- Miscellaneous
- Eroding abdominal aortic aneurysm
- Malignant hypertension
- Loin pain–hematuria syndrome
- Renal vein thrombosis
- Exercise-induced hematuria
- Cantharidin (Spanish fly) poisoning
- Stings/bites by insects/reptiles having venom with anticoagulant properties
- Schistosomiasis
- Sickle Cell Trait
Diagnosis
Work-Up
- UA
- CBC
- Chemistry
- Albumin (often reduced in acute glomerulonephritis)
- C3, C4, ASO
Management
Defer to nephrologist
Disposition
Coordinate with nephrologist