0521779407-08 CUNY1086/Karliner 0 521 77940 7 June 13, 2007 7:47
Glomerular Diseases 631■Urine:Urinalysis, 24 hr urine for protein and creatinine, in select
cases UPEP.
■Specific Diagnostic Tests:
■ANA, serum complement, in select cases VDRL, SPEP, ANCA, ASLO,
Hepatitis B and C serology, anti-GBM antibodies.
■Other Tests:renal ultrasound, renal biopsy in select cases.differential diagnosis
■Distinguish from other fluid retaining states:CHF, liver disease
(only NS has periorbital edema), hyperlipidemic states, conditions
with proteinuria but less than nephrotic levels (HBP).
Determine which syndrome best fits the patient
■Nephrotic syndrome (NS) characterized by: proteinuria, edema,
hypoalbuminemia, and hyperlipidemia.
■Minimal change disease: most common in children, up to 5–10%
adults with idiopathic NS; rarely seen with NSAIDs, lithium use,
Hodgkin’s disease-Leukemias; sudden onset severe edema
■Focal segmental glomerulosclerosis: Up to 25% of idiopathic
nephrotic syndrome; Most common pattern in Blacks with idio-
pathic NS. Secondary forms seen with HIV, obesity, remnant kidneys,
reflux, sickle cell disease, heroin nephropathy
■Membranous Nephropathy: Most common pattern idiopathic NS
in Caucasians; Secondary forms with gold salts, NSAIDs, syphilis,
Hepatitis B and rarely C, SLE
■Membranoproliferative GN (MPGN): Most patients have Hepatitis C
MPGN or cryoglobulinemia; young females r/o SLE
■Glomerulonephritis characterized by edema, hypertension, oliguria
and urine sediment with rbc and rbc casts
■IgA Nephropathy: Most common form of idiopathic GN in world.
Presents in young persons with gross hematuria (dark or Coca Cola
urine) after exercise or upper resp infection. Presents in older persons
as asymptomatic microhematuria and proteinuria. 10% present with
severe nephritis and rapid renal failure or NS. Small overlap with
Henoch Schoenlein purpura (HSP) (IgA vasculitis with skin, GI tract,
arthritis, and more severe kidney disease)
■Post-Streptococcal GN: Follows certain strains of ß-hemolytic strep-
tococcal throat, skin and other infections; Onset 10 days to 2 wks post
infection with dark urine (Coca Cola color), edema, HBP, oliguria,
and renal dysfunction. Most have low C3 during acute phase. Only
few percent of adults have severe course with renal failure or heavy
proteinuria