Acute Glomerulonephritis Investigations

Urinalyis MSU Biopsy

Urinalysis Urine is dark. Specific gravity is greater than 1020 osm. Proteinuria is observed. Haematuria RBCs and red cell casts are present on microscopy (Perform FBE to check for anaemia) Leukocytes Creatinine level increased http://home.caregroup.org/Urinalysis_Tutorials/The%20Nephritic%20Syndrome.3.pdf http://emedicine.medscape.com/article/777272-diagnosis

Asymptomatic urinary abnormalities Isolated proteinuria without haemturia May be early sign of glomerular lesion- i.e. membranous GN, IgA nephropathy, diabetic nephropathy or amyloidosis Haematuria with/without sub-nephrotic range proteinuria SLE, Henoch-Schonlein purpura, post-infectious GN

Blood FBE ESR, CRP for inflammation U + E’s LFT’s Serum albumin (low in nephrotic syndrome) Glucose- to exclude diabetes Serum complement (low in SLE) Auto-antibodies: serum immunoglobulins, ANCA (Wegener’s granulomatosus, anti-ss-DNA (SLE)

Imaging Chest radiography needed in patients with a cough, with or without haemoptysis (ie, Wegener granulomatosis, Goodpasture syndrome, pulmonary congestion). Abdominal CT is needed if visceral abscesses are suspected; also look for chest abscesses. Echo For pts with new cardiac murmur or a positive blood culture rules out endocarditis or a pericardial effusion. Renal US: to evaluate kidney size as well as to determine the extent of fibrosis. A kidney size of less than 9 cm is suggestive of extensive scarring and a low likelihood of reversibility CT scan of the head for patient with malignant hypertension or altered mental status.

Biopsy Candidates for biopsy: individual or family history of renal disease, atypical presentation: massive proteinuria nephrotic syndrome rapid rise in creatinine level without resolution.

Post-strep GN Biopsy shows diffuse, florid, acute inflamm at the glomerulus No necrosis, but occaisonal crescents Neutrophils and deposition of IgG and complement Light microscopy of biopsy sample shows acute inflammation of glomerulus with neutrophils

http://www. health-res http://www.health-res.com/EX/07-30-11/poststreptococcal_acute_diffuse_proliferative_glomerulonephritis_02.jpg

IgA nephropathy (commonest form of GN) Elevated IgA complex in mesangium Biopsy shows mesangial cell proliferation and increased matrix

Wegener’s granulomatosus C- ANCA that reacts with proteinase 3