may just present with edema

NEPHRITIC urine
Dysmorphic RBCs,
RBC casts
Low mod
proteinuria

Inflammatory, progress fast

Glomerulonephritis
Normal

C3, C4

ANCA (+)

non-inflammatory, progress slow

Hepa%%s'C'accounts(for(8%(of(ESRD.(
Three(pa6erns:(2ndry(MPGN;(
Cryoglobulenemic;(Membranous(Nephropathy(

ANCA (-)

NEPHROTIC urine
No casts (hyaline, if any), few RBCs
Heavy proteinuria (>3 g/d),
hypoalbuminemia (<3g/dL);
lipidemia

Primary Renal Disease:

Minimal Change Disease (MCD)

SX: most common cause in children; can

occur in adults; acute onset; precipitant of
Pauci-immune GN
IgA Nephropathy
bee sting, viral infection; associated with
Category of ANCA positive GN
SX: Abnormal IgA deposit in mesangium;
Postinfectious
Hodgkins and other T-cell malignancies;
associate with small vessel
genetic; most common primary
SX: GABHS; 1-3 weeks after
dramatic weight gain, edema, normal BP
vasculitis;
glomerular disease worldwide; micro to
untreated pharyngitis or impetigo;
DX: biopsy (not kids); fusion of podocytes
gross hematuria; classic presentation of
common in children; more severe in ANCA are Ab against proteins in
TX: Oral prednisone (empiric); cyclophos
adults; sudden onset; peri-orbital edema cytoplasmic granules of neutrophils painless hematuria w/ viral illness (40%
and monocytes; triggers
! transient renal failure; less than 10% Membranous Nephropathy
DX: Elevated Anti-steptolysin Ab;
SX: most common cause of primary
inflammatory
response
not
related
! RPGN) interemittent hematuria
TX: underlying infection; anti-HTN/
to
complement
DX: Biopsy; LM, IF, EM (no serum blood nephrotic syndrome in adults; coagulopathy
diuretics; steroids of no value
& renal vein thrombosis;
Two Categories:
test exists)
Lupus nephritis
Cytoplasmic (cANCA) = diffuse
TX: supportive or immunosuppresives if Immune mediated; eval for malignancy
SX: Autoimmune w/ Ab production;
Primary ! Ag is phospholipase A2 receptor
Perinuclear (pANCA) = localized
severe
women in 20/30s;SZ; anemia
on podocyte
TX for all: High dose corticosteroids Henoch-Schonlein
DX: Need 4 or more classification
Secondary ! carcinoma, endocarditis, Hep
& cyclophosphamide
SX: anaphylactoid purpura; small
criteria; Ab to dsDNA or Smith Ab;
B, SLE BX for DX
Idiopathic
vessel leukocytoclastic vasculitis; IgA
Antinuclear Ab test positive;
FSGS
deposition in mesangium; common in
Granulomatosis
Antiphospholipid Ab (IgG or IgM)
SX: Most common cause in young adults;
children;
more
sever
in
adults
AKA: Granulomatosis with
TX: Renal Biopsy directs therapy
can occur in MCD resistant to steroids
Tetrad:
abd
pain,
renal
disease,
palpable
Polyangiitis (Wegeners)
MPGN (often Hep C)
DX: Biopsy; LM & EM; fusion of podocytes
purpura
(LE
&
Butt),
arthritis/arthralgia
SX: Fever, Purulent rhinorrhea,
SX: Idiopathic; may present with
Systemic Disorders:
(adult;
knee/ankle);
nephrotic pattern; younger than 30 nasal ulcers, sinus pain,
Possible
GI
bleeding;
lots
of
Ag
causes
polyarthralgias/arthritis, cough,
Diabetes
DX: not postinfectious; rule out
DX: clinical dx; skin bx helpful; renal bx SX: >10yrs; albuminuria before GFR
hemoptysis,
SOB,
lupus w/ lupus titer; get Hep C titer;
not necessary (crescent sclerosis)
DX: CXR = nodular lesion
decline; retinopathy (refer to Ophth)
Need BX to determine DX
TX: self limiting (1-6 weeks); no steroids DX: biopsy rarerly needed, scarring/sclerosis
MPA
SBE
Anti-GBM/Goodpastures
TX: manage DM
DX:Subacute Bacterial Endocarditis; Microscopic Polyangiitis
SX:
autoimmune
Ab
to
epitope
in
BM;
SX:
similar
to
Wegeners;
rarely
Amyloid
Unusual; immune complex
GN
+
Pulmonary
Hemorrhage
have
lung
disease
or
destructive
deposition of fibrous protein amyloid;
deposition
(hemoptysis after URTI); Hx smoking
sinusitis
Plasma Cell Dyscrasias ! overproduction of
Cryoglobulin
DX: CXR ! pulmonary hemorrhage;
DX: biopsy ! vasculitis w/out
Ig light chain (Primary renal amyloidosis;
SX: precipitates of cryoglobulin in
Labs ! Fe-def anemia; Anti-GBM-Ab;
granulomas
Multiple myeloma) Secondary Amyloid !
glomerular capillaries; usually Hep
Renal
Biopsy
!
Crescentic
pattern
serum amyloid A deposits in tissues; large
C; purpura; necrotizing skin lesions; Churg-Strauss
TX:
Methyl
Prednisolone
IV
x
3
days
kidneys
SX: small vessel vasculitis
arthralgias; fever;
then
oral
Prednisolone
&
associated w/ eosinophilia; dont
HIV associated
hepatosplenomegaly
Cyclophosphamide & Plasma Exchange Rapid GFR decline; hypercoag; ARF; ACE
worry
about
this
one
DX: Serum Cryoglobulins
every other day until anti-GBM-Ab gone
Sometimes MPGN
TX: IFN-Alpha

Low