Aidan at 00:11, 15 September 2020

2020-09-15T00:11:17Z

Aidan: Text replacement - "([Ss])olid-organ" to "$1olid organ"

2020-08-07T13:52:38Z

Text replacement - "([Ss])olid-organ" to "$1olid organ"

← Older revision		Revision as of 13:52, 7 August 2020
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Maintenance script: Imported from text file

2020-07-04T01:17:36Z

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See also:

* [[Nephritic syndrome]]
* [[Nephrotic syndrome]]

== Classification ==

* Nephrotic syndrome
** Protein >3g/day
** Edema
** Hyperlipidemia
** Hypoalbuminemia <35g/L
* Nephritic syndrome
** Active urinalysis with RBCs and/or casts
** Hypertension
** Azotemia
** Can present with nephrotic syndrome if severe

== Differential Diagnosis ==

{|
! Cause
!align="center"| MCD
!align="center"| MN
!align="center"| FSGS
!align="center"| FPGN
!align="center"| MPGN
!align="center"| DPGN
!align="center"| RPGN
|-
| '''Primary'''
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| '''Infections'''
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|-
| HIV
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| Malaria
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| Syphilis
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| Hepatitis B
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| Hepatitis C
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| '''Drugs'''
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| Heroin use
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| Gold and penicillamine
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| Pamidronate
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| Lithium
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| NSAIDs
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| '''Neoplasms'''
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| Hodgkin lymphoma
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| Non-Hodgkin lymphoma
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| Solid-organ malignancy
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| '''Autoimmune/Inflammatory'''
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| Lupus
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| Post-infectious GN
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| Mixed cryo
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| IgA nephritis
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| Anti-GBM (linear)
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| ANCA-assoc (pauci-immune)
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| '''Miscellaneous'''
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| Renal transplant rejection
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| Obesity
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|}

MCD = minimal change disease; MN = membranous nephropathy; FSGS = focal segmental glomerulosclerosis; FPGN = focal proliferative GN; MPGN = membranoproliferative GN; DPGN = diffuse proliferative GN; rapidly-progressive GN

== Differential Diagnosis ==

* '''Non-proliferative''' (nephrotic syndrome, > 3 g/day)
** Minimal change disease
*** Primary: most common cause in children
*** Hodgkin lymphoma
** Focal segmental glomerulosclerosis
*** Primary
*** HIV
*** African-American (apo-L1 gene)
** [[Membranous nephropathy]]
*** Primary: common in adults
*** Cancer (non-Hodgkin lymphoma and solid tumours)
*** Drugs (NSAIDs, gold, penicillamine)
*** Infections (malaria, HBV, HCV)
*** Lupus
* '''Proliferative''' (nephritic syndrome)
** Membranoproliferative
*** Primary
*** Transplant rejection
*** HCV
** Focal proliferative
*** Primary
*** IgA nephropathy
*** Lupus nephritis
** Diffuse proliferative
*** Primary
*** Hypocomplementemia
**** Lupus
**** Post-infectious nephropathy
**** Essential mixed cryoglobulinemia
** Rapidly-progressing glomerulonephritis (RPGN)
*** Primary
*** Linear immunofluorescence: anti-GBM, Goodpastures
*** Lumpy-bumpy immunofluorescence: post-infectious, lupus
*** Negative immunofluorescence: ANCA vasculitides
* Non-glomerulonephritis
** Diabetes
** Amyloidosis

{|
!
! Minimal Change
! Membranous
! FSGS
! MPGN
! Nodular
|-
| Secondary causes
| Hodgkin lymphoma
| HBV, SLE, solid tumours (lung, breast, GI)
| Reflux netphropathy, HIV, HBV, obesity, sickle cell disease
| HCV, malaria, SLE, leukemia, lymphoma, shunt nephritis
| Diabetes, amyloidosis
|-
| Drugs
| NSAIDs
| Gold, penicillamine
| Heroin
|
|
|-
| Therapy
| Steroids
| BP control, ACEi, steroids
| Steroids, ACEi for protein
| ASA, ACEi
| Underlying cause
|}

<pre class="mermaid">graph LR;
GN --> ANCA[ANCA positive]
ANCA --> cANCA[c-ANCA/PR3]
cANCA --> GPA
ANCA --> pANCA[p-ANCA/PR3]
pANCA --> eGPA[eGPA]
pANCA --> MPA[MPA]
GN --> GBM[Anti-GBM positive]
GBM --> hemopt[Hemoptysis]
hemopt --> Goodpasture[Goodpasture's]
GBM --> no_hemoptysis[No hemoptysis]
no_hemoptysis --> antiGBM[Anti-GBM disease]
GN --> Complement[Complement-mediated]
Complement --> low_C3[Low C3]
low_C3 --> low_C3_syndromes[PSGN, MPGN, SLE, IE, cryo]
Complement --> normal_C3[Normal C3]
normal_C3 --> normal_C3_syndromes[IgA nephropathy, fibrillary GN]
</pre>
== Investigations ==

* SPEP/UPEP for amyloidosis
* HbA1c for diabetes
* If nephrotic:
** Lipid profile
** Albumin
** 24h urine
* If suspecting lupus: ANA ±dsDNA ±Sm, C3/C4, ESR/CRP
* HIV/HBV/HCV
* If suspecting vasculitides
** Anti-GBM antibody
** ANCAs

== Management ==

* Age < 20 years, treat empirically with prednisone
* Age > 20 years, needs kidney biopsy first
* Treatment depends on pathology
** Minimal change disease
*** Low salt diet and lasix for edema, ACEi/ARB for hypertension
*** Prednisone 60mg/day

[[Category:Nephrology]]

Glomerulonephritis - Revision history

Aidan at 00:11, 15 September 2020

Aidan: Text replacement - "([Ss])olid-organ" to "$1olid organ"

Maintenance script: Imported from text file