Urine analysis showed blood and protein +++, leukocytes +, negative nitrites, with granular casts present. She had crackles to the mid zones. Her creatinine was 232umol/L on admission and Hb 77g/L with blister like cells present. [anzsnasm.com]

At presentation the median plasma creatinine was 2.15 mg/dl (1.2–4.1) without significant difference between the two groups. [academic.oup.com]

Crescents may be present, and extraglomerular involvement usually is mild. Nephritis is present in 80% of cases of Henoch-Schönlein purpura and manifests as a nephrotic urine sediment and moderate proteinuria. [emedicine.medscape.com]

At presentation, the median age was 54 years, and 33 patients were hypertensive, 31 had nephritic syndrome, eight had nephrotic syndrome and 11 had non-nephrotic proteinuria. [moh-it.pure.elsevier.com]

Fourteen patients (46.6%) presented at least one renal flare (RF) during the follow up for a total of 21 flares. At our last observation, 18 (60%) presented a good renal outcome while 12 (40%) had a poor outcome. [ncbi.nlm.nih.gov]

• Fever of Unknown Origin

  Patients typically present with a fever of unknown origin and an active sediment. Although renal biopsy is used to detect immune deposits containing IgG and C3, serum complement levels usually are within the reference range. [emedicine.medscape.com]

• Turkish

  GATA Nefroloji BD, Ankara, Türkiye Turkish J Nephrol 2009; 18: 85-86 Keywords : Type 2 diabetes mellitus, Non-diabetic renal disease, Acute exudative diffuse proliferative glomerulonephritis Read: 114 Downloads: 66 Published: 13 February 2019 Volume 18 [turkjnephrol.org]

• Splenectomy

  […] virus C in three), four had malignant neoplasia (two colon cancer, one testis seminoma and one myeloma), five had diabetes mellitus, three had chronic obstructive lung disease with bronchiectasis, one had thalassemia intermedia and was submitted to splenectomy [academic.oup.com]

• Sputum

  Background: 79-year-old woman after 3 doses of Etanercept (last 10 days prior to admission) presented with one week history of non-bloody diarrhoea, vomiting, shortness of breath, cough productive of pink sputum, oliguria, rose coloured urine and a non-blanching [anzsnasm.com]

• Blood in Stool

  Blood and stool cultures negative. [anzsnasm.com]

• Hepatosplenomegaly

  Her lungs were clear, there was no heart murmur, no hepatosplenomegaly, and no significant leg edema or other rash. There was mild, occasional synovitis in the PIPS and MCPs in both hands. [renalandurologynews.com]

• Heart Murmur

  Her lungs were clear, there was no heart murmur, no hepatosplenomegaly, and no significant leg edema or other rash. There was mild, occasional synovitis in the PIPS and MCPs in both hands. [renalandurologynews.com]

• Smoky Urine

  One week later he passed smoky urine and after a further week he passed bright red urine. At that time there was oedema of the sacrum and tenderness over the renal angles. The B.P. was 130/80. Blood and albumen but no casts were found in the urine. [lo.unisa.edu.au]

  He denied any history of abdominal pain, fever, dysuria, smoky urine, gross hematuria, sore throat, skin infection, joint pains, skin rash and oral ulcers. He was diagnosed with ADPKD, and his mother also had the disease. [cyberleninka.org]

Identifying the pattern of injury is only the beginning of the workup in many cases! [arkanalabs.com]

• Microalbuminuria

  Chapman AB, Johnson AM, Gabow PA, Schrier RW: Overt proteinuria and microalbuminuria in autosomal dominant polycystic kidney disease. J Am Soc Nephrol 1994, 5:1349-1354. 2. Dalgaard OZ: Bilateral polycystic disease of kidney. [cyberleninka.org]

• Creatinine Decreased

  In eight of them, renal insufficiency partially improved during the first year (median plasma creatinine decreased from 4.4 to 2 mg/dl). [academic.oup.com]

[…] glomerulonephritis Initiate treatment with high-dose corticosteroids early. [emedicine.medscape.com]

Belimumab is a human monoclonal antibody to B cell stimulating factor used in the treatment of SLE. However, there are no available randomized controlled trials to support its use as an induction agent in treatment of lupus nephritis. [renalandurologynews.com]

ALTERNATIVE TREATMENTS For patients who are reluctant to receive CYC or who are intolerant or refractory to the drug, other treatments can be considered. [ard.bmj.com]

Suría S, Checa MD: Mycophenolate mofetil in the treatment of lupus nephritis, in patients with failure, intolerance or relapses after treatment with steroids and cyclophosphamide. Nefrologia. 2007, 27: 459-65. 2. [bmcnephrol.biomedcentral.com]

Most of the patients improved (84 per cent) after six months of initial treatment with either program. [nejm.org]

Infection-associated glomerulonephritis is rare in adults and its long-term prognosis is undefined. Methods. [moh-it.pure.elsevier.com]

Histological findings may also be helpful in assessing the prognosis. There is a general agreement that crescents are a forerunner of a bad prognosis [ 6, 11, 14 ]. [academic.oup.com]

Title Long-term prognosis of diffuse proliferative glomerulonephritis asspciated with infection in adults Publication Type Journal Article Year of Publication 2002 Moroni G, Pozzi C, Quaglini S, Segagni S, Banfi G, Baroli A, Picardi L, Colzani S, Simonini [labmedinfo.org]

Background Severe renal manifestation of systemic lupus erythematosus (SLE) is not uncommon and is associated with an indeterminate prognosis. [opus4.kobv.de]

Prognosis Evidence of glomerulosclerosis, fibrous crescents, tubular atrophy, and, particularly, interstitial fibrosis on light microscopy indicates advanced disease and a poor prognosis. [emedicine.medscape.com]

Epidemiology APGN can occur in both adults and children; however, post- streptococcal etiologies are much more common in children. [pathwaymedicine.org]

A (IgA) nephropathy and SLE are the most common etiologies. [emedicine.medscape.com]

Figure 1: Etiological classification of nephrotic syndrome. DM, diabetes mellitus; SLE, systemic lupus erythematosus. [jesnt.eg.net]

To a large extent, the etiologic differential diagnosis depends on the immunofluorescence and ultrastructural findings. [arkanalabs.com]

The development of the immune complex–mediated glomerulonephritis 1 week after the first dose of paclitaxel, negative work-up for other potential etiologies, previous evidence in the literature of autoimmune-mediated reactions induced by paclitaxel, and [ascopubs.org]

[…] course therapy with Cyc might be effective in controlling disease activity but demonstrated high rate of RF and poor renal outcome over time; however, this protocol might represent an effective therapeutic strategy in a subgroup of patients with specific epidemiological [ncbi.nlm.nih.gov]

Author Affiliations From the divisions of Nephrology and Rheumatology, Department of Internal Medicine; the Department of Pathology and Anatomy; and the Department of Medical Statistics and Epidemiology, Mayo Clinic and Mayo Foundation, Rochester, MN [nejm.org]

Epidemiology APGN can occur in both adults and children; however, post- streptococcal etiologies are much more common in children. [pathwaymedicine.org]

Shunt nephritis is an immune complex–mediated glomerulonephritis that develops as a complication of chronic infection on ventriculoatrial or ventriculojugular shunts inserted for the treatment of hydrocephalus [4] Epidemiology Frequency United States [emedicine.medscape.com]

Epidemiology of primary glomerular diseases in a French region. Variations according to period and age. Kidney Int 1994 ; 46 : 1192 –1198 3 Levy M. Infection‐related proteinuric syndromes In: Cameron JS, Glassock RG, eds. The Nephrotic Syndrome. [academic.oup.com]

Definition / general Also called post streptococcal or acute glomerulonephritis; a type of diffuse endocapillary proliferative glomerulonephritis Pathophysiology Deposition of immune complexes from antibodies against organisms elicits acute inflammatory [pathologyoutlines.com]

[…] range proteinuria (< 3.5 g/day) if the nephritic syndrome is severe enough it can lead to nephrotic range proteinuria (> 3.5 g/day) renal biopsy may be necessary to arrive to a definitive diagnosis and to determine prognosis Nephritic Syndrome Type Pathophysiology [step1.medbullets.com]

Pathophysiology Most cases of DPGN result from the deposition of immune complexes in the mesangium, glomerular basement membrane (GBM), subendothelial or subepithelial locations. [emedicine.medscape.com]

Pathophysiological advances in membranous nephropathy: time for a shift in patient's care. The Lancet. 2015;385(9981):1983-92. Ronco P, Debiec H. Membranous nephropathy: A fairy tale for immunopathologists, nephrologists and patients. [researchsquare.com]

Prevention There may be no way to prevent most forms of glomerulonephritis. However, here are some steps that might be beneficial: Seek prompt treatment of a strep infection with a sore throat or impetigo. [mayoclinic.org]

Tissue distribution of HRF20, a novel factor preventing the membrane attack of homologous complement, and its predominant expression on endothelial cells in vivo. Immunology 1990 ; 70: 145 – 149. [journals.sagepub.com]

Immunosuppression must be sufficient both to prevent further antibody production and to treat kidney inflammation. [6] Immunosuppression should be discontinued by 12 months, as no benefit has been demonstrated with more prolonged therapy. [emedicine.medscape.com]

LJP 394 for the prevention of renal flare in patients with systemic lupus erythematosus: Results from a randomized, double-blind, placebo-controlled study. Arthritis Rheum 2003 ; 48 : 442 –54. ↵ Wallace DJ. [ard.bmj.com]

This type of diagnostic discrimination will undoubtedly help in the prevention and reversal of these diseases and increase our understanding of the mechanisms involved in primary renal disease i.e. glomerulonephritis. [jpma.org.pk]