Diferencia entre revisiones de «Glomerulonephritis»

Revisión del 08:29 13 jul 2016

Background

Characterized by hematuria and proteinuria

Causes of Glomerulonephritis

Clincal Presentation

History
- Recent URI or skin infection (strep)
- Rash, arthralgia (HSP, SLE)
- Fever, vomiting, diarrhea (HUS)
Often associated with hypertension
Hematuria, proteinuria, RBC casts

Differential Diagnosis

Hematuria

Sources of hematuria.

Urologic (lower tract)
- Any location
  - Iatrogenic/postprocedure
  - GU trauma
  - Infection
  - Kidney stone
  - Erosion or mechanical obstruction by tumor
- Ureter(s)
  - Dilatation of stricture
- Bladder
  - Transitional cell carcinoma
  - Vascular lesions or malformations
  - Chemical or radiation cystitis
- Prostate
  - Benign prostatic hypertrophy
  - Prostatitis
- Urethra
  - Stricture
  - Diverticulosis
  - Foreign body
  - Endometriosis (cyclic hematuria with menstrual pain)
Renal (upper tract)
- Glomerular
  - Glomerulonephritis
  - IgA nephropathy (Berger disease)
  - Lupus nephritis
  - Hereditary nephritis (Alport syndrome)
  - Toxemia of pregnancy
  - Serum sickness
  - Erythema multiforme
- Nonglomerular
  - Interstitial nephritis
  - Pyelonephritis
  - Papillary necrosis: sickle cell disease, diabetes, NSAID use
  - Vascular: arteriovenous malformations, emboli, aortocaval fistula
  - Malignancy
  - Polycystic kidney disease
  - Medullary sponge disease
  - Tuberculosis
  - Renal trauma
Hematologic
- Primary coagulopathy (e.g., hemophilia)
- Pharmacologic anticoagulation
- Sickle cell disease
Myoglobinuria - positive blood, no RBCs: rhabdomyolysis
Hemoglobinuria - positive blood, no RBCs
Miscellaneous
- Eroding abdominal aortic aneurysm
- Malignant hypertension
- Loin pain–hematuria syndrome
- Renal vein thrombosis
- Exercise-induced hematuria
- Cantharidin (Spanish fly) poisoning
- Stings/bites by insects/reptiles having venom with anticoagulant properties
- Schistosomiasis
- Sickle Cell Trait

Diagnosis

Work-Up

UA
CBC
Chemistry
Albumin (often reduced in acute glomerulonephritis)
C3, C4, ASO

Management

Defer to nephrologist

Disposition

Coordinate with nephrologist

References

Authors:

@@ Línea 7: / Línea 7: @@
 *History
 **Recent URI or skin infection (strep)
-**[[Rash]], arthralgia (HSP, SLE)
+**[[Rash]], [[arthralgia]] (HSP, SLE)
 **[[Fever]], [[vomiting]], [[diarrhea]] (HUS)
-*Often a/w HTN
+*Often associated with hypertension
 *[[Hematuria]], [[proteinuria]], RBC casts