Mrs. EB Mesangiocapillary Glomerulonephritis

Pt Background Mrs. EB is a 62 yo female currently experiencing end stage renal failure (ESRF) 2 ⁰ to Mesangiocapillary Glomerulonephritis which she was diagnosed with 16 years ago.

Hx of presenting complaint Pt presented with ▫Pyrexia ▫Aches ▫Swollen hands and feet

Renal History Change in colour/smell of urine ▫Haematuria Dysuria Change in volume and stream ▫Nocturia, polyurua, anuria Fever/loin pain Bruising/itching Oedema Prostatism ▫Poor stream, difficulty starting, dribbling

Examination General appearance ▫Colour, swelling, AV fistula, catheter Hands ▫Leukonychia, anaemia, asterixis Arm ▫BP (lying then standing) Face ▫Anaemia, jaundice, uraemic fetor, skin colour Neck ▫JVP, auscaltate carotid arteries

Examination ctd. Chest ▫Praecordium, auscultate lung bases Abdomen ▫Palpate & percuss liver & spleen, kidney punch, ballot kidneys, auscultate for renal bruits, palpate and auscultate a.aorta, examine fermoral pulse & radio- femoral delay, rectal exam Back ▫Vertebral tenderness, sacral oedema Lower limbs ▫Oedema, inspect skin, capillary refill,

Urinalysis Specific gravity pH Protein Blood ▫WBC ▫RBC Microscopy ▫Casts (damage to the glom basement mem or tubules)

Mx Dx with Mesangiocapillary Glomerulonephritis by biopsy. Did not respond to corticosteriods (as expected). Started on diuretics and an ACE inhibitors

16 yrs later Presented with malaise, weight increase and oedema. Creatinine was above 500 (70-150) umol/L Kidney function 5-10% Corticosteroids failed again Started on haemodialysis due to ESRF

Mesangiocapillary GN There is no proven treatment 50% of pts develop ESRF Oxford Handbook of Clinical Medicine