shared:renal:glomerular_disease
Table of Contents
Glomerular Disease
Nephrotic Syndrome
Nephritic Syndrome
- Low complement: post-infectious GN, SLE, MPGN
- Normal complement: IgA, Anti-GM (Goodpasture's)
Epidemiology
- Age < 15 years:
- Nephrotic: MCD, FSGS
- Nephritic: IgA, Hsp, post-infectious GN, MPGN, Alport
- Age 15-40 years:
- Nephrotic:
- Nephritic:
- Age > 40 years:
- Nephrotic:
- Nephritic:
Common causes
- Hypocomplementemic
- Primary renal: acute post-strep, MPGN
- Systemic disease: SLE, IE, cryo, HCV
- Normocomplementemics
- Other infections (uncomm): M. leprae, P. facipraum, P. malariae, S. mansoni, Filatriasis
Lab abnormalities
- UA: proteinuria, hematuria, casts
- GFR intitially decreased
- Streptococcal antibody profile
- C3, C4 and/or CH50 depressed in 50%
Nephrotic Syndrome
- Causes
- Minimal change glomerulopathy
- Membranous glomerulopathy: PLA2R, HLA-DQA1 secondary cause in 30%; often self limiting, treat with steroid + Cytoxans
- FSGS: 5-12%, more common in AA; normal C4, C3, C2
- Primary
- Secondary
- Familial/genetic
- Viral (HIV/Parvovirus B19)
- Drug-induced (heroin, IFN-alpha, lithium, pamidronate)
- Mediated by responses
- MPGN (also nephritic)
- Primary
- Type I: mesangiocapillary (more common)
- Type II: dense deposit disease (5%)
- Type III: mixed pattern
- Secondary
- IgA (Berger's)
- common in Asia (>30%), Europe (20-25%), US (10%)
- overproduction of IgA1
- Fibrillary GN
- Diabetic glomerulopathy
- Amyloidosis
- Light chain deposition disease
- Approach
- History/physical
- Lab: CrCl, SPEP/UPEP, lipids, cholesterol, complements, ANA, cryoglobulin, hepatitis serologies
- Renal biopsy: when no clear cause evident, or possible cause with atypical course
Rapidly Progressive Glomerulonephritis
- Clinical term
- Often associated with crescentic
- Immunofluorescence pattern:
- Antibody mediated
- Goodpasture's (anti-GBM with lung involvement)
- anti-GBM without lung involvement
- Pauci-immune
- Microscopic
- Wegner's (ANCA, mostly PR3)
- Immune-complex mediated
HUS/TTP
- Features
- Thrombocytopenia
- MAHA
- Acute renal failure
- Neurological symptoms/signs
- Fever
- Adult
- Idiopathic/ADAMSTS13 deficiency
- Hereditary defector of plasma factor H
- Drugs
SLE
- Classes
- I. No abnormalities: no treatment (guided by extrarenal symptoms)
- II. Mesangial lupus nephritis: corticosteroids
- III. Focal segmental lupus nephritis (<50%): corticosteroids + immunosupressive agents
- IV. Diffuse proliferative lupus nephritis (>50%): cyclophosphamide pulses, methylprednisone pulses, oral prednisone, azathioprine
- V. Membranous lupus nephritis: corticosteroids with/without immunosuppresive agents
- VI. Advanced sclerosing lupus nephritis: dialysis, transplantation
shared/renal/glomerular_disease.txt · Last modified: 2020/02/25 17:34 by 127.0.0.1