GLOMERULONEPHRITIS

Hematuria - Protenuria - WBCs - ↑BUN - ↑Creatnine

Immunologic (anti-body induced injury) - affects both kidneys equally

Assess exposure to Rx, immunizations, microbial infections, viral infections (hepatitis)

ACUTE POSTSTREPTOCOCCAL

GLOMERULONEPHRITIS

Onset = 5-7(21)days (often seen in children, eg; strep-throat)

Hematuria - Proteinuria - BUN is normal to high (r/t nitrogenous wastes)

Dx = Erythrocytes in dipstick

Body Edema (initial periorbital edema)

HTN - Oliguria - Smokey urine from upper urinary tract - possible flank/abdmnl pain

Tx = Rest until labs high values decrease including BP

       Low-protein, low sodium diet, fluid restriction (r/t edema)

       PCN if strep is still present

GOOD PASTURE SYNDROME

Rare autoimmune disease - happens to young male smokers - presence of circulating antibodies against glomerular and alveolar basement membranes

Onset = Fast

Hematuria - Proteinuria - ↑BUN -

RF - flu-like Sx - Weakness - Pallor - Anemia - Pulmonary issues (adventitous LS) - ↓H&H - Hemorrhage

Manage w/ corticosteroids, immunosuppresants (cytoxan, imuran), plasmapherisis, and dialysis, renal transplant (after ↓anti-GBM antibodies)

CHRONIC GLOMERULONEPHRITIS

Reflects end stage of glomerular disease

Slow Development - pt may present w/ no known Hx of renal issues - Biopsy=Dx cause

Hematuria - Proteinuria

HTN - Uremia

Tx = supportive and symptomatic - Tx HTN and UTIs aggresively

         restrict protein and phosphate

NEPHROTIC SYNDROME

Immune response - Glomerulus is excessivley permeable to plasma protein - Proteinuria→low plasma albumin + tissue edema - Often ass. w/ DM and SLE

(NO Hematuria) - Massive Proteinuria - Casts in urine - Fatty bodies in urine - ↓Albumin - ↑Lipids - ↓Serum Protein - ↓Cholesterol - ↓Clotting Factors - ↑Coaguloabiliy

Edema - Asites - Anasarca - HTN - ↑Risk for infection 

Skeletal abnormalities - r/t hypocalcemia & hyperparathyroidism - Thromboembolism in renal vein and PE often occurs

Tx = Relieve edema, use ACE inhibitors cautiously, NSAIDS, low sodium (2-3g/day), and low-moderate protein (0.5g/kg/day), thiazide loop diuretics, lower cholesterol w/ Mavecor/Colestid, Prednisone = severe cases, weigh pt. and replace protein