CURRENT Essentials of Critical Care.pdf

208 Current Essentials of Critical Care■■■Glomerulonephritis, AcuteEssentials of Diagnosis• Oliguria, hypertension, edema (especially periorbital distribution),pulmonary congestion, fatigue• Nausea, dyspnea, lethargy, pericarditis, encephalopathy if severerenal failure present• “Nephritic” urinary sediment with red cell casts, red cells (maybe dysmorphic [acanthocytes]), low urinary MCV ([urine/bloodMCV 1]), white cells; variable proteinuria• History and physical may identify temporally associated infectionsor systemic vasculitis• Obtain immunological markers: antinuclear antibodies (ANA),antineutrophil cytoplasmic antibodies (ANCA), anti-GBM antibodies,antistreptolysin O (ASO) titer, HIV, hepatitis B/C antibodies,complement, cryoglobulinsDifferential Diagnosis• IgA nephropathy/Berger disease• Henoch-Schönlein purpura• Lupus nephritis• Goodpasture syndrome and anti-GBM disease• Wegener granulomatosis• Microscopic polyangiitis and other vasculitides• Poststreptococcal GN• Hepatitis B and C associated GN• Infective endocarditisTreatment• Renal biopsy for pathological confirmation• Supportive management with sodium and fluid restriction• Blood pressure control• Most etiologies require aggressive immunosuppressive regimenssuch as high-dose steroids and cyclophosphamide• Plasmapheresis may be effective in anti-GBM or cryoglobulinassociateddiseases• Dialysis in renal failure■ PearlRapidly progressive glomerulonephritis (RPGN) is associated with arapid decline in renal function leading to end-stage renal failurewithin days to weeks. Crescent formation within glomeruli on renalbiopsy is the pathological hallmark of this syndrome.ReferenceVinen CS et al: Acute glomerulonephritis. Postgrad Med J 2003;79:206.[PMID: 12743337]