Features
- Rapid onset
- Hypertension
- AKI
- Mild proteinuria (2+ on dipstick, <3.5 g/day)
- Glomerular hematuria (RBC casts, dysmorphie RBCs)
Approach
- UA with microscopy to evaluate for proteinuria/hematuria, as well as dysmorphic RBCs or RBC casts
- C3/C4 levels within normal limits
- pANCA positive (Anti-myeloperoxidase, perinuclear, or Anti-MPO Antibody) (see Small Vessel Vasculitis)
- Eosinophilic granulomatosis with polyangiitis (EGPA, formerly Churg-Strauss):
- Associated with asthma, chronic rhinosinusitis, peripheral eosinophilia
- Microscopic polyangiitis (MPA)
- May have associated sinusitis or other ENT symptoms. Associated with mononeuritis multiplex
- Eosinophilic granulomatosis with polyangiitis (EGPA, formerly Churg-Strauss):
- c-ANCA positive (Anti-proteinase 3, or Anti-PR3 Antibody)
- Granulomatosis with polyangiitis (GPA, formerly Wegener’s)
- Inflammation of upper and lower airway, may have associated cough, sinusitis, or shortness of breath
- Associated with mononeuritis multiplex
- Granulomatosis with polyangiitis (GPA, formerly Wegener’s)
- ANCA-negative
- IgA Nephropathy
- Classically presents after a viral upper respiratory infection or physical exertion
- IgA Vasculitis (Henoch-Schonlein Purpura)
- Classically presents in children and includes abdominal pain, leukocytoclastic vasculitis, and arthralgias. May also present after an acute viral upper respiratory infection
- Anti-GBM disease
- Goodpasture’s Syndrome if associated with pulmonary hemorrhage
- IgA Nephropathy
- pANCA positive (Anti-myeloperoxidase, perinuclear, or Anti-MPO Antibody) (see Small Vessel Vasculitis)
- C3/C4 levels below normal limits
- Post-streptococcal glomerulonephritis
- ~1-3 weeks after Group A streptococcal illness (skin or pharynx). Diagnosis: Anti-Streptolysin O (ASO) serology. Streptozyme: includes anti-nicotinamide-adenine dinucleotidase (anti-NAD), anti-DNAse B, and anti-hyaluronidase (AHase). Most sensitive. Treatment is supportive
- Staphylococcal glomerulonephritis
- Concurrent infection or up to one month after infection. Diagnostic evaluation includes clinical evidence of very recent or current staphylococcal infection and rulin out other etiologies. Treatment is focused on treating underlying infection
- Endocarditis
- Diagnose with blood cultures, transesophageal echocardiogram (TEE). Treat underlying infection.
- Membranoproliferative Glomerulonephritis (MPGN)
- Associated with HBV, HCV. Treat underlying etiology
- Cryoglobulinemia
- Cryoglobulins are immunoglobulins that precipitated at temperatures < 37 degrees Celsius (2). Positive Rheumatoid Factor. Classic complement pattern includes normal C3 and very low C4. Associated with most infections (most commonly HCV), malingnancy, autoimmune disorders (3). Associated symptoms include purpura and arthralgias. Diagnose with serum cryoglobulins.
- Post-streptococcal glomerulonephritis
References
- Rawla, P. (2020, August 08). Poststreptococcal Glomerulonephritis. Retrieved January 02, 2021, from https://www.ncbi.nlm.nih.gov/books/NBK538255/
- Chen, Y., Cheng, H., Rui, H., & Dong, H. (2019, July 20). Cryoglobulinemic vasculitis and glomerulonephritis: Concerns in clinical practice. Retrieved January 02, 2021, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6759094/
- Ramos-Casals, M., Stone, J. H., Cid, M. C., & Bosch, X. (2012). The cryoglobulinaemias. The Lancet, 379(9813), 348-360. doi:https://doi.org/10.1016/S0140-6736(11)60242-0
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