0521779407-08 CUNY1086/Karliner 0 521 77940 7 June 13, 2007 7:47
632 Glomerular Diseases■Rapidly progressive glomerulonephritis: Proliferative GN progress-
ing to renal failure in weeks to months; Sudden onset of oliguria,
dark urine, HBP, and renal dysfunction. Biopsy with proliferation in
Bowman’s space i.e. crescents. Three patterns based on pathogenesis
and Course:
➣Type I: Anti-GBM disease
➣Type II: Immune Complex
➣Type III: Pauci-immune (ANCA positive)
■May be associated with systemic symptoms
■Anti-GBM disease with pulmonary disease and hemorrhage (Good-
pasture’s)
➣Pauci-immune with vasculitis, upper and lower respiratory
(Wegener’s)
➣Immune Complex associated with Henoch Schoenlein Purpura
(see above) SLE, post-streptococcal disease (see above)
■Asymptomatic urinary findings: isolated microscopic hematuria
and/or proteinuria. In hereditary GN due to Alport’s synd hearing
defects, lens defects eye. Biopsy often deferred if normal Ccr and
<1 gm proteinuria/day. Due to:
➣hereditary nephritis (Alport’s, thin basement membrane dis),
➣early stage of a progressive GN
■Glomerular Disease associated with systemic diseases
■See sections on DM, SLE, Amyloidosis, Hepatitis B and C, HIV dis-
easemanagement
■Control edema: loop diuretics (start with low dose BID, increase pro-
gressively)
➣add second diuretic – metolozone
➣low salt diet
➣rarely albumin infusion with diuretics
■Control lipids: Low cholesterol, low saturated fat diet
➣HMG Co-A reductase (statin) therapy
➣Try to reduce cholesterol to 200 mg/dl and LDL to <160 mg/dl
■Control hypertension: ACE inhibitors and ARBs first line since reduce
proteinuria
➣(watch K+and BUN/ creatinine)
■Watch for hypercoagulable state (pulmonary emboli and renal vein
thrombosis)
➣Especially if serum albumin <2 g/dl or pt has membranous NS
■Dialysis for renal failure