Presentation
In all cases, the number of RTCs was within normal limits or slightly increased, and a variable number of non-G1DEs were present in 161 cases. [ncbi.nlm.nih.gov]
May present with the nephrotic syndrome. May present with the nephritic syndrome. [what-when-how.com]
Just over 2/3 of patients were dialysis-dependent on presentation. [renalfellow.blogspot.com]
For example, some patients present with nephrotic-range proteinuria and active urine sediments, whereas others present with nephrotic-range proteinuria and acute renal failure. [jamanetwork.com]
Entire Body System
- Fatigue
She also reported having fatigue, dizziness, and decreased appetite. A week before the onset of symptoms, a mild upper respiratory tract infection had developed. [nejm.org]
Symptoms Some common symptoms of glomerular disease are: High blood pressure Decreasing frequency of urination Fluid retention Swelling in lower legs, face, feet and abdomen Fatigue Blood loss in urine Causes The causes include: Genetic factors Thin basement [medanta.org]
As many people have no symptoms, it may take a routine check-up or tests linked to hypertension or fatigue to reveal glomerulonephritis. Diagnosis can be difficult, as the causes are often unknown. [medicalnewstoday.com]
[…] rheumatoid arthritis, or chronic infections, although the latter are much less common in recent decades.71,72 Most patients with amyloidosis in the United States have immunoglobulin light chain–associated disease.73 Accompanying systemic symptoms (eg, fatigue [jamanetwork.com]
- Weight Loss
Common symptoms include inflammation of kidney, weight loss, skin lesions, nerve damage and fevers. [omicsonline.org]
In such patients, aggressive kidney protective/antiproteinuria therapy is recommended, including weight loss if obese. If these measures fail to control progression, kidney biopsy might then be indicated. [karger.com]
Diet, physical activity, weight loss in the obese, and reduction of the doses of steroids and CNI whenever possible are effective measures to minimize glucose intolerance in transplant recipients. [cjasn.asnjournals.org]
loss) and/or cardiac involvement are common, although other organs may be affected. [jamanetwork.com]
- Malaise
Beta Blockers A 43-year-old man has had increasing malaise for the past 3 weeks. PE he has a BP of 150/95 mmHg and 1+ pitting edema of the lower extremities to the knees. [quizlet.com]
Sudden onset in a young child - malaise, fever, nausea, oliguria, hematuria, Edema, mild - moderate hypertension, elevation of BUN Urine - RBC casts, proteinuria Lab - antistreptococcal antibody titre, C3 34. 95% -- children recover, < 1% [slideshare.net]
It typically occurs 1–4 weeks after a pharyngeal infection with this bacterium, and is likely to present with malaise, a slight fever, nausea and a mild nephritic syndrome of moderately increased blood pressure, gross haematuria, and smoky-brown urine [en.wikipedia.org]
- Weight Gain
gain due to swelling Foamy or bubbly urine Hypertension Glomerular Disease Diagnosis Diagnosis of glomerular disease is made using urine and blood tests and genetic testing and kidney biopsy when necessary. [mottchildren.org]
Retention of salt and water causes weight gain and ankle swelling. [omicsonline.org]
Musculoskeletal
- Arthralgia
He notes no sore throat, fever, chills, myalgias, arthralgias, or flank pain. There is no family history of renal disease. Urinalysis shows 1+ protein with 30-50 RBC but no WBC. The same symptom complex occurred 6 months and twelve months earlier. [quizlet.com]
Presentation is usually purpuric rash, arthralgia, peripheral neuropathy and glomerulonephritis. Rx - plasma exchange Excess antibody production by benign or malignant plasma cells. [brainscape.com]
Skin: non-blanching purpura (legs / buttocks) - Joints: transient arthralgias - GI: abdominal pain, vomiting, melena (dark smelly stool w/ blood), hematochezia (fresh blood in stool) - Kidney: hematuria, proteinuria, rarely progressive renal failure [cram.com]
Purpura, arthralgias, and other signs of vasculitis in patients with glomerulonephritis and low serum complement levels raise the suspicion of cryoglobulinemia. [jamanetwork.com]
Urogenital
- Kidney Failure
In many cases, CKD leads to kidney failure. What are kidney failure and end-stage renal disease? Kidney failure is the acute or chronic loss of 85 percent or more kidney function. [niddk.nih.gov]
Kidney biopsy helps to identify problems of the kidneys at the cellular level. Top of Page Treatment Although glomerular disease has different causes, it can lead to kidney failure. [kidneyhealthcare.com]
Hemodialysis If left untreated, glomerular disease could lead to complications such as high blood pressure, acute kidney failure, chronic kidney failure and nephrotic syndrome. Acute kidney failure is likely to occur with acute glomerulonephritis. [medanta.org]
Sometimes you may need medication or temporary treatment with an artificial kidney machine to remove extra fluid, control high blood pressure and treat kidney failure. [kidney.org]
However, complete kidney failure can result. [medicalnewstoday.com]
- Oliguria
Slight oliguria and rise in BUN Maintenance: oliguria, salt and water overload, rising BUN, hyperkalemia, metabolic acidosis Recovery: increase in urinary output (up to 3L/day), hypokalemia, BUN returns to normal. [pathologystudent.com]
The pathophysiology of glomerular diseases is complex; most patients present with either nephritic syndrome (low-level proteinuria, microhematuria, oliguria, and hypertension) or nephrotic syndrome (high-level proteinuria and generalized edema). [amboss.com]
Nephritic syndrome is nephritic urine sediment with or without hypertension, elevated serum creatinine, and oliguria. [merckmanuals.com]
CASE DESCRIPTION: A 70 year old female k/c/o DM for 10 years presenting with anasarca, puffiness of face, nausea, vomiting, weakness, hiccups, oliguria and itching all over body. Her renal and diabetic profile were deranged with huge proteinuria. [ayurlog.com]
- Microscopic Hematuria
blood in the urine Nephritic syndrome: Proteinuria Microscopic hematuria - blood in urine that can only be seen by a microscope Edema Hypertension Rapidly Progressive Glomerulonephritis (RPGN) - nephritic syndrome plus a relatively rapid loss of kidney [pennmedicine.org]
Microscopic hematuria. N Engl J Med. 2003;348:2330-2338. Donadio JV, Grande JP. IgA nephropathy. N Engl J Med. 2002;347:738-748. McCarthy HJ, Tizard EJ. Clinical practice: Diagnosis and management of henoch-schonlein purpura. [the-hospitalist.org]
Many patients have only mild to moderate proteinuria (150 mg to 3 g/24 hr) or microscopic hematuria (> two red blood cells [RBCs] per high-power field). Others present with painless gross hematuria. [what-when-how.com]
Minor complications (hematomas not requiring transfusion and microscopic hematuria with flank pain) occurred in 5% of patients. This study found that a PKB performed for GN or preeclampsia led to changes in management in 66% of patients. [kidneynews.org]
- Flank Pain
pain, proteinuria, and a new kidney mass. [nejm.org]
Minor complications (hematomas not requiring transfusion and microscopic hematuria with flank pain) occurred in 5% of patients. This study found that a PKB performed for GN or preeclampsia led to changes in management in 66% of patients. [kidneynews.org]
His renal failure in the setting of the sudden development of gross hematuria with flank pain is concerning for a renal vein thrombosis, and an abdominal magnetic resonance venography did in fact visualize a renal vein thrombosis. [the-hospitalist.org]
[…] epididymitis精巣上体炎 erectile dysfunction (ED)勃起不全 erythropoietinエリスロポエチン essential hypertension本態性高血圧 etymology語源 excrete排出する(される) excretory urography排泄性尿路造影 extracellular fluid (ECF)細胞外液 extracorporeal shock wave lithotripsy (ESWL)体外衝撃波結石破砕 f flaccid type 弛緩型 flank [tokyo-med.ac.jp]
Workup
Acute Kidney Injury Workup. Medscape Reference. Available online at http://emedicine.medscape.com/article/243492-workup#c13. Accessed May 2016. (April 2014) Seaborg E. New Biomarkers Offer Hope for Identifying Acute Kidney Injury Risk. [labtestsonline.it]
Patients who fail to respond to treatment are referred for early kidney transplant workup and the philosophy of this group is to avoid dialysis if possible. [mayo.edu]
Diagnosis of Nephrotic Syndrome Because of these considerations, our recommendations for the initial workup of adults with nephrotic syndrome are outlined in Table 6. [jamanetwork.com]
[…] bisphophonates Malignancy Leukemia, Lymphoma Infection Syphillis, HIV, Hepatitis Allergy Associated with multiple environmental allergies Again though, secondary MCD is very uncommon, and a diagnosis of MCD does not confer any risk of having (or prompt a “workup [unckidneycenter.org]
Because MN may also be associated with malignancy or infection, the workup for post-transplant MN should include a careful search for underlying cancer or viral infection. [cjasn.asnjournals.org]
Urine
- Microalbuminuria
An 8-year-old patient with this disease and severe rickets due to medically resistant hypophosphatemia was found to have the previously unrecognized complication of renal glomerular hyperfiltration, microalbuminuria, and diffuse glomerular mesangial expansion [ncbi.nlm.nih.gov]
Prevalence of microalbuminuria, arterial hypertension, retinopathy and neuropathy in patients with insulin dependent diabetes. Br Med J (Clin Res Ed). 1988;296156- 160Google ScholarCrossref 65. [jamanetwork.com]
Diabetic nephropathy is the single most common cause of progressive renal failure in the United States.3 Up to 50% of patients with diabetes present with diabetic nephropathy.19 Current recommendations are to screen yearly for microalbuminuria at the [the-hospitalist.org]
- Acanthocytes
If glomerular hematuria is present, usually at least 1/20 red cells is an acanthocyte. Cellular casts are far less common than acanthocytes [ 3 ]. [karger.com]
Treatment
Different findings on biopsy can suggest various causes and can be helpful in prognosis and determining treatment. Treatment Multiple treatments are available. [med.stanford.edu]
Services offered by the Glomerular/Renal Parenchymal Disease Clinic Comprehensive medical evaluation and treatment including: Multidisciplinary approach to diagnosis and treatment of glomerular diseases Evaluation of patients experiencing common conditions [mayoclinic.org]
A biopsy will help your healthcare provider plan the best treatment for you. What treatment is available for glomerular disease? Your healthcare provider will need to find what is causing your glomerular disease. [kidney.org]
While a trial of treatment may still be indicated, I believe a rapid re-assessment of the patient’s condition and need for continued immunosuppressive therapy is indicated given the high infectious risks with treatment. [renalfellow.blogspot.com]
Washington University offers SLE patients a multidisciplinary approach to diagnosis and treatment of SLE. [renal.wustl.edu]
Prognosis
Different findings on biopsy are extremely helpful in establishing prognosis and determining treatment. [med.stanford.edu]
New-onset post-transplant diabetes may worsen both the patient and graft prognosis. [cjasn.asnjournals.org]
This also may cause proteinuria which is usually mild and overall prognosis is excellent. [en.wikipedia.org]
[…] and nephrotic disorders differs substantially, but their clinical overlap is considerable—eg, several disorders may manifest with the same clinical picture—and the presence of hematuria or proteinuria does not itself predict response to treatment or prognosis [merckmanuals.com]
Etiology
They may be classified by clinical severity, by histological changes in the kidney, or by etiology. [medical-dictionary.thefreedictionary.com]
In the absence of kidney disease/kidney biopsy registry in Nepal, the exact etiology of different forms of glomerular disease is primarily unknown in our country. [sjkdt.org]
“This study looking at a vast and diverse population across 17 countries and 4 continents provide further insights into the epidemiology of glomerular disease and also underscore the complexity behind the etiology of glomerulonephropathies,” said John [renalandurologynews.com]
HIV - variant is associated Obesity Black patients - defect in CD2AP slit pore protein What is the etiology of membranous nephropathy? What does imaging show and how do patients respond to treatment? MCC nephrotic syndrome in older patients. [brainscape.com]
Epidemiology
The epidemiology and prognosis of glomerulonephritis in Denmark 1985-1997. Nephrol Dial Transplant. 1999;14(8):1889-97. [ Links ] 13. Swaminathan S, Leung N, Lager DJ, et al. [scielo.br]
In this Review, Scott Cohen and colleagues outline the epidemiology of renal disease in HIV and how it has changed since the introduction of combined antiretroviral therapy. [nature.com]
Sim, MD, who has conducted epidemiologic studies of glomerular diseases but was not involved in the new study. “The findings suggest the interplay and importance of both nature and nurture on glomerular disease.” [renalandurologynews.com]
Establishing a renal biopsy registry provides valuable epidemiological and clinical data of renal diseases with a histological diagnosis. [bmcnephrol.biomedcentral.com]
Pathophysiology
Summary Definition Pathophysiology Overview glomerular diseases Nephrotic vs. nephritic syndrome [amboss.com]
This edition has been thoroughly revised by world-renowned contributors to reflect recent developments in renal pathophysiology. [books.google.com]
The pathophysiology of nephritic and nephrotic disorders differs substantially, but their clinical overlap is considerable—eg, several disorders may manifest with the same clinical picture—and the presence of hematuria or proteinuria does not itself predict [merckmanuals.com]
[…] practice patterns across the world that may confound the interpretation of some of these [new study’s] findings,” Dr Sim said, “this study further supports previous work and emphasizes the need to consider the multifactorial mechanisms underlying the pathophysiology [renalandurologynews.com]
Prevention
Thus, quick diagnosis and immediate initiation of immunosuppressive therapy are required to prevent irreversible kidney damage. [amboss.com]
Glomerular diseases are the third leading cause of end stage renal disease; however, if treated early, progression can potentially be prevented. [gwdocs.com]
The molecular mechanism that normally prevents Fn deposition appears to involve high-affinity binding of UG with Fn to form Fn-UG heteromers that counteract Fn self-aggregation, which is required for abnormal tissue deposition. [ncbi.nlm.nih.gov]
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]