Glomerulonephritis

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)
• 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
• Hematologic
  • Primary coagulopathy (e.g., hemophilia)
  • Pharmacologic anticoagulation
  • Sickle cell disease
• Myoglobinuria - positive blood, no RBCs: rhabdomyolysis
• Hemoglobinuria - positive blood, no RBCs
  • TTP / HUS
  • DIC
  • Mechanical valve emergency
  • Hemolytic anemia
  • Paroxysmal Nocturnal Hemoglobinuria
• 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

Evaluation

Work-Up

• UA
• CBC
• Chemistry
• Albumin (often reduced in acute glomerulonephritis)
• C3, C4, ASO

Management

Defer to nephrologist

Disposition

Coordinate with nephrologist