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2.1
Renal Glomerular Disease
Glomerular Diseases

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]

MCC primary glomerular disease Presentation - young man who develops macroscopic haematuria 1-2 days after URTI. Can also present with asymptomatic haematuria, proteinuria and renal impairment. [brainscape.com]

Just over 2/3 of patients were dialysis-dependent on presentation. [renalfellow.blogspot.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 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]

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]

    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]

    Acute kidney failure. Available online at http://www.mayoclinic.com/health/kidney-failure/DS00280. Accessed March 2014. Mayo Clinic. Nephrotic syndrome. [labtestsonline.it]

    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]

  • 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]

    Signs and symptoms The symptoms of glomerular disease include: Edema (swelling) in different parts of the body Reddish, brownish, or pinkish urine Foamy urine Oliguria (reduced urine output) The signs which might be picked up on urine and blood testing [news-medical.net]

    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]

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]

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]

Washington University offers SLE patients a multidisciplinary approach to diagnosis and treatment of SLE. [renal.wustl.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]

Prognosis

New-onset post-transplant diabetes may worsen both the patient and graft prognosis. [cjasn.asnjournals.org]

Different findings on biopsy are extremely helpful in establishing prognosis and determining treatment. [med.stanford.edu]

This also may cause proteinuria which is usually mild and overall prognosis is excellent. [en.wikipedia.org]

[…] excellent Isolated Hematuria/Benign recurrent hematuria -Defined as asymptomatic hematuria after other possibilities are excluded -Renal biopsy normal -50% remission after 5 years, good prognosis Crescent formation in the glomeruli are commonly seen [quizlet.com]

Etiology

They may be classified by clinical severity, by histological changes in the kidney, or by etiology. [medical-dictionary.thefreedictionary.com]

“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]

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]

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]

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]

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]

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