Breakdown of Glomerular Disease

Breakdown of Glomerular Disease

1. Asymptomatic Microscopic Haematuria

   • >5% Dysmorphic cells and Red cell casts strongly suggestive of Glomerular origin
   • Persistent non-glomerular haematuria in patients older than 40 warrants cyctoscopy for bladder malignancy. (Rarely found in patients less than 40)

2. Asymptomatic Proteinuria

   • Microalbuminuria
     • 300mg/24hours or ACR of 0.3
     • Diabetes or hypertension predominant causes
   • Non-nephrotic proteinuria
     • <3.5grams/24hours or PCR of <3
     • Many non-glomerular causes
     • If persistent for greater than 6 months, or in the presence of declining GFR warrants biopsy

3. Asymptomatic Haematuria and Proteinuria

   • Highly suggestive of glomerular disease, even at low levels of proteinuria
   • Always warrants biopsy

4. Nephrotic syndrome

   • Cardinal Features
     • Heavy Oedema (periorbital often a clue)
     • Heavy Proteinuria >3.5gm/24hrs
     • Hyperlipidaemia/Lipiduria
     • Usually hypoalbuminaemia
       • note hypercoagulable when albumin < 20, significant proportion get clots
     • May or may not have renal excretory impairment
     • Onset is usually insidious over months
   • Common underlying lesions
     • Minimal Change
     • FSGS
     • Membranous nephropathy
     • Membranoproliferative GN Type I
     • Membranoproliferative GN Type II
     • Diabetic nephropathy
     • Amyloidosis
   • General/Non-specific mangament
     • Oedema
       • Diuresis
       • Na+ restriction
     • Antiproteinuric Agents
       • Proven to decrease progression to ESRF
       • Small initial reduction in excretory function
     • Prothrombotic state
       • Prophylactic anticoagulation including long term aspirin
       • Maintain high clinical suspicion for VTE's
     • Infection risk
       • Cellulitis in areas of oedema
       • infected fluid collections eg. Ascites, effusions

5. Nephritic syndrome/ Rapidly progressive GN

   • Cardinal features
     • Hypertension
     • Haematuria
     • "Active urinary sediment"
     • Impaired excretory function
       • Decreased GFR
       • Decreased UO
     • Non-nephrotic proteinuria
   • Common underlying lesions
     • Immune complex diseases
       • IgA Nephropathy / HSP
       • Lupus Nephritis
       • Post-strep GN
     • Vssculitis
       • ANCA pos
         • WG (c-ANCA)
         • MPA (p-ANCA)
       • pauci-immune
     • Goodpastures
     • Endocarditis related