Proteinuria, hematuria (microscopic or gross), renal insuflciency, and HTN. Depending upon
What are the characteristics of glomerular disease?
the cause, systemic symptoms may also be present.
A 10 y/o is brought to the clinic with her mother for dark urine. The mother mentions that the
child was complaining of sore throat and cough/cold symptoms two ago. The urine shows Postinfectious (Poststreptococcal) glomerulonephritis
gross hematuria without nitrites or leukocytes.
Presentation varies from asymptomatic with only microscopic findings on urinalysis to that of a
What is the typical clinical presentation of postinfectious GN? nephritic syndrome: gross hematuria, HTN, edema, and acute renal failure. Symptoms appear
2-3 weeks after streptococcal pharyngitis or other bacterial infection
Urine sediment reveals dysmorphic RBCs or RBC casts and proteinuria (occasionally nephrotic
What are the characteristic laboratory findings of postinfectious GN?
range); serum studies are remarkable for hypocomplementemia, positive ASO titer.
LM - Glomerular hypercellularity, with epithelial and endothelial cell proliferation, and an
inflammatory glomerular infiltrate composed of neutrophils. Capillary lumens are usually
What are the renal biopsy characteristics for LM, IF, EM? obliterated. Crescents may be present.
IF - Granular deposition of IgG and C3 in the glomerular tuft
EM - Large, irregular, subepithelial "hump"-shaped deposits
No specific therapy other than the treatment of the underlying infection in most cases. A trial of
What is the appropriate management of postinfectious GN? steroids may be indicated if renal failure is severe. There is no evidence supporting aggressive
immunosuppression.
Self-limited, with Cr returning to baseline in <6 weeks in most cases; hematuria typically re-
What is the prognosis of postinfectious GN? solves within 6 months. 15% of patients with poststreptococcal GN have persistent proteinuria
at 3 years, 2% at 7-10 years. Progression to ESRD is rare, as is recurrence.
A 33-year-old man comes to the ED because of blood in his urine for 2 days. He has also been
feeling unwell, with a sore throat, running nose, cough, and fever. Medical history includes
three episodes of hematuria in the past that have spontaneously resolved. His temperature
is 98.9°F; pulse is 82/min; respirations are 18/min, and blood pressure is 145/90 mm Hg. IgA nephropathy
PE is normal. Urinalysis shows moderate numbers of erythrocytes, a few leukocytes, red cell
casts, and a large amount of protein. No bacteria are cultured. A renal biopsy demonstrates
large dark mesangial deposits.
Gross hematuria with or without proteinuria during viral upper respiratory tract infection or
What is the typical clinical presentation of IgA nephropathy? GI illness, persistent microscopic hematuria, and sometimes associated dull flank pain, with
a 2:1 male predominance, often presenting in the second and third decades of life
What are the most common conditions with which IgA nephropathy is associated? Liver disease (e.g., alcoholic cirrhosis), inflammatory bowel disease, celiac sprue, and HIV
Normal or decreased renal function, persistent microhematuria, and variable proteinuria;
What are the characteristic laboratory findings of IgA nephropathy?
urine sediment reveals dysmorphic RBCs and RBC casts
LM - Focal or dittuse mesangial proliferation with matrix expansion. Crescents may or may not
be present.
What are the renal biopsy characteristics of IgA nephropathy for LM, IF, EM?
IF - Globular IgA deposition in the mesangium and capillary walls
EM - Electron dense mesangial deposits
Most patients will benefit from ACE-I or ARB to reduce proteinuria and BP, as well as a statin.
What is the appropriate management of IgA nephropathy? Patients with nephrotic range proteinuria may also benefit from the addition of fish oil, while
patients with more severe disease require immunosuppression
Patients without proteinuria and who have preserved GFR have a low risk of progressing to
What is the of IgA nephropathy of IgA nephropathy?
ESRD. Of patients who develop proteinuria, 30% will progress slowly to ESRD within 30 years
A 26-year-old man presents with hematuria, periorbital edema, and jaundice. He has a
medical history of opioid use disorder with prior hospitalizations for a heroin overdose. He
is on Suboxone but is non-adherent. His blood pressure is 162/102 mmHg. Physical exami-
1/3
What are the characteristics of glomerular disease?
the cause, systemic symptoms may also be present.
A 10 y/o is brought to the clinic with her mother for dark urine. The mother mentions that the
child was complaining of sore throat and cough/cold symptoms two ago. The urine shows Postinfectious (Poststreptococcal) glomerulonephritis
gross hematuria without nitrites or leukocytes.
Presentation varies from asymptomatic with only microscopic findings on urinalysis to that of a
What is the typical clinical presentation of postinfectious GN? nephritic syndrome: gross hematuria, HTN, edema, and acute renal failure. Symptoms appear
2-3 weeks after streptococcal pharyngitis or other bacterial infection
Urine sediment reveals dysmorphic RBCs or RBC casts and proteinuria (occasionally nephrotic
What are the characteristic laboratory findings of postinfectious GN?
range); serum studies are remarkable for hypocomplementemia, positive ASO titer.
LM - Glomerular hypercellularity, with epithelial and endothelial cell proliferation, and an
inflammatory glomerular infiltrate composed of neutrophils. Capillary lumens are usually
What are the renal biopsy characteristics for LM, IF, EM? obliterated. Crescents may be present.
IF - Granular deposition of IgG and C3 in the glomerular tuft
EM - Large, irregular, subepithelial "hump"-shaped deposits
No specific therapy other than the treatment of the underlying infection in most cases. A trial of
What is the appropriate management of postinfectious GN? steroids may be indicated if renal failure is severe. There is no evidence supporting aggressive
immunosuppression.
Self-limited, with Cr returning to baseline in <6 weeks in most cases; hematuria typically re-
What is the prognosis of postinfectious GN? solves within 6 months. 15% of patients with poststreptococcal GN have persistent proteinuria
at 3 years, 2% at 7-10 years. Progression to ESRD is rare, as is recurrence.
A 33-year-old man comes to the ED because of blood in his urine for 2 days. He has also been
feeling unwell, with a sore throat, running nose, cough, and fever. Medical history includes
three episodes of hematuria in the past that have spontaneously resolved. His temperature
is 98.9°F; pulse is 82/min; respirations are 18/min, and blood pressure is 145/90 mm Hg. IgA nephropathy
PE is normal. Urinalysis shows moderate numbers of erythrocytes, a few leukocytes, red cell
casts, and a large amount of protein. No bacteria are cultured. A renal biopsy demonstrates
large dark mesangial deposits.
Gross hematuria with or without proteinuria during viral upper respiratory tract infection or
What is the typical clinical presentation of IgA nephropathy? GI illness, persistent microscopic hematuria, and sometimes associated dull flank pain, with
a 2:1 male predominance, often presenting in the second and third decades of life
What are the most common conditions with which IgA nephropathy is associated? Liver disease (e.g., alcoholic cirrhosis), inflammatory bowel disease, celiac sprue, and HIV
Normal or decreased renal function, persistent microhematuria, and variable proteinuria;
What are the characteristic laboratory findings of IgA nephropathy?
urine sediment reveals dysmorphic RBCs and RBC casts
LM - Focal or dittuse mesangial proliferation with matrix expansion. Crescents may or may not
be present.
What are the renal biopsy characteristics of IgA nephropathy for LM, IF, EM?
IF - Globular IgA deposition in the mesangium and capillary walls
EM - Electron dense mesangial deposits
Most patients will benefit from ACE-I or ARB to reduce proteinuria and BP, as well as a statin.
What is the appropriate management of IgA nephropathy? Patients with nephrotic range proteinuria may also benefit from the addition of fish oil, while
patients with more severe disease require immunosuppression
Patients without proteinuria and who have preserved GFR have a low risk of progressing to
What is the of IgA nephropathy of IgA nephropathy?
ESRD. Of patients who develop proteinuria, 30% will progress slowly to ESRD within 30 years
A 26-year-old man presents with hematuria, periorbital edema, and jaundice. He has a
medical history of opioid use disorder with prior hospitalizations for a heroin overdose. He
is on Suboxone but is non-adherent. His blood pressure is 162/102 mmHg. Physical exami-
1/3
