Podcast
Questions and Answers
In the presented case of a 26-year-old male with recurrent swelling and proteinuria, which of the following findings would most strongly suggest a diagnosis of nephrotic syndrome rather than a nephritic syndrome?
In the presented case of a 26-year-old male with recurrent swelling and proteinuria, which of the following findings would most strongly suggest a diagnosis of nephrotic syndrome rather than a nephritic syndrome?
- Elevated serum creatinine.
- Presence of red blood cell casts in urine.
- Presence of hypertension.
- Absence of haematuria. (correct)
A patient with nephrotic syndrome exhibits a markedly elevated creatinine clearance rate. Which pathophysiological mechanism most likely contributes to this finding in the early stages of the disease?
A patient with nephrotic syndrome exhibits a markedly elevated creatinine clearance rate. Which pathophysiological mechanism most likely contributes to this finding in the early stages of the disease?
- Increased proximal tubular reabsorption of creatinine.
- Decreased glomerular filtration coefficient (Kf).
- Reduced tubular secretion of creatinine.
- Increased glomerular filtration of plasma water, secondary to hypoalbuminemia-induced hyperfiltration. (correct)
Considering the long-term management of a patient with nephrotic syndrome, why are ACE inhibitors or ARBs prescribed, even in the absence of frank hypertension?
Considering the long-term management of a patient with nephrotic syndrome, why are ACE inhibitors or ARBs prescribed, even in the absence of frank hypertension?
- To prevent thromboembolic events by reducing platelet aggregation.
- To protect renal function by reducing intraglomerular pressure and proteinuria, thereby slowing the progression of chronic kidney disease. (correct)
- To directly reduce proteinuria by altering glomerular permeability.
- To manage hypercholesterolemia by increasing LDL receptor activity.
A patient with nephrotic syndrome develops a sudden onset of flank pain, haematuria, and lower limb swelling. Which of the following complications should be the primary concern?
A patient with nephrotic syndrome develops a sudden onset of flank pain, haematuria, and lower limb swelling. Which of the following complications should be the primary concern?
In a child presenting with nephrotic syndrome who is initially responsive to steroid therapy but subsequently develops frequent relapses, what pathological finding would be LEAST likely to be seen on renal biopsy?
In a child presenting with nephrotic syndrome who is initially responsive to steroid therapy but subsequently develops frequent relapses, what pathological finding would be LEAST likely to be seen on renal biopsy?
Why does nephrotic syndrome increase the risk of infection, particularly with encapsulated organisms?
Why does nephrotic syndrome increase the risk of infection, particularly with encapsulated organisms?
A patient with long-standing nephrotic syndrome presents with dyspnoea and chest pain. Which of the following complications is most likely?
A patient with long-standing nephrotic syndrome presents with dyspnoea and chest pain. Which of the following complications is most likely?
What is the primary rationale for using lipid-lowering agents (statins) in patients with nephrotic syndrome?
What is the primary rationale for using lipid-lowering agents (statins) in patients with nephrotic syndrome?
In a 26-year-old male with nephrotic syndrome effectively managed with steroids, why is it important to periodically assess for occult infections even in the absence of overt symptoms?
In a 26-year-old male with nephrotic syndrome effectively managed with steroids, why is it important to periodically assess for occult infections even in the absence of overt symptoms?
A patient with known Focal Segmental Glomerulosclerosis (FSGS) develops nephrotic syndrome post-kidney transplant. What is the most likely underlying mechanism for the recurrence of FSGS in the allograft?
A patient with known Focal Segmental Glomerulosclerosis (FSGS) develops nephrotic syndrome post-kidney transplant. What is the most likely underlying mechanism for the recurrence of FSGS in the allograft?
In the context of IgA glomerulonephritis, what is the significance of assessing for systemic symptoms during diagnosis?
In the context of IgA glomerulonephritis, what is the significance of assessing for systemic symptoms during diagnosis?
A 47-year-old male presents with hypertension, haematuria, and a recent upper respiratory tract infection (URTI). Renal biopsy reveals IgA deposition in the mesangium. How does the URTI likely contribute to the pathogenesis of IgA glomerulonephritis in this case?
A 47-year-old male presents with hypertension, haematuria, and a recent upper respiratory tract infection (URTI). Renal biopsy reveals IgA deposition in the mesangium. How does the URTI likely contribute to the pathogenesis of IgA glomerulonephritis in this case?
A patient with IgA glomerulonephritis is being assessed using the Oxford scoring system (MEST-C). What does the 'E' in MEST-C specifically refer to in this classification?
A patient with IgA glomerulonephritis is being assessed using the Oxford scoring system (MEST-C). What does the 'E' in MEST-C specifically refer to in this classification?
In the Oxford classification (MEST-C) for IgA nephropathy, the presence of which histological feature is most indicative of a poorer prognosis?
In the Oxford classification (MEST-C) for IgA nephropathy, the presence of which histological feature is most indicative of a poorer prognosis?
In differentiating between glomerular and non-glomerular causes of haematuria, why is the presence of dysmorphic red blood cells in the urine significant?
In differentiating between glomerular and non-glomerular causes of haematuria, why is the presence of dysmorphic red blood cells in the urine significant?
A patient presents with haematuria, proteinuria, and a family history of Alport's syndrome. What genetic inheritance pattern is most commonly associated with Alport's syndrome?
A patient presents with haematuria, proteinuria, and a family history of Alport's syndrome. What genetic inheritance pattern is most commonly associated with Alport's syndrome?
In the workup for glomerular haematuria, why is it important to inquire about a patient’s history of recent infections, particularly upper respiratory infections?
In the workup for glomerular haematuria, why is it important to inquire about a patient’s history of recent infections, particularly upper respiratory infections?
Which immunological mechanism primarily contributes to the development of glomerular injury in IgA nephropathy?
Which immunological mechanism primarily contributes to the development of glomerular injury in IgA nephropathy?
Considering the various causes of glomerulonephritis, which condition is most likely to present with both pulmonary haemorrhage and rapidly progressive glomerulonephritis (RPGN)?
Considering the various causes of glomerulonephritis, which condition is most likely to present with both pulmonary haemorrhage and rapidly progressive glomerulonephritis (RPGN)?
Why might early stages of nephrotic syndrome lead to a normal or even raised creatinine clearance?
Why might early stages of nephrotic syndrome lead to a normal or even raised creatinine clearance?
What is the rationale behind using ACE inhibitors in nephrotic syndrome, even in normotensive patients?
What is the rationale behind using ACE inhibitors in nephrotic syndrome, even in normotensive patients?
Why are individuals with nephrotic syndrome at increased risk of thromboembolic events?
Why are individuals with nephrotic syndrome at increased risk of thromboembolic events?
Which of the following factors is LEAST likely to contribute to oedema formation in nephrotic syndrome?
Which of the following factors is LEAST likely to contribute to oedema formation in nephrotic syndrome?
A child with nephrotic syndrome improves with steroid treatment but relapses frequently. Which finding is most suggestive of minimal change disease rather than focal segmental glomerulosclerosis (FSGS)?
A child with nephrotic syndrome improves with steroid treatment but relapses frequently. Which finding is most suggestive of minimal change disease rather than focal segmental glomerulosclerosis (FSGS)?
Which of the following is the most appropriate initial treatment strategy for hyperlipidaemia in a patient with nephrotic syndrome?
Which of the following is the most appropriate initial treatment strategy for hyperlipidaemia in a patient with nephrotic syndrome?
A patient with nephrotic syndrome develops acute abdominal pain. Which of the following is the most likely underlying cause?
A patient with nephrotic syndrome develops acute abdominal pain. Which of the following is the most likely underlying cause?
A renal biopsy from a patient with nephrotic syndrome shows global effacement of podocyte foot processes on electron microscopy. What is the most likely underlying cause of this pathological finding?
A renal biopsy from a patient with nephrotic syndrome shows global effacement of podocyte foot processes on electron microscopy. What is the most likely underlying cause of this pathological finding?
A patient with known IgA nephropathy presents with acute kidney injury following an upper respiratory infection. Which of the following pathological findings is MOST likely to be observed on renal biopsy?
A patient with known IgA nephropathy presents with acute kidney injury following an upper respiratory infection. Which of the following pathological findings is MOST likely to be observed on renal biopsy?
A patient with IgA nephropathy develops end-stage renal disease and requires a kidney transplant. What is the primary concern regarding the transplanted kidney?
A patient with IgA nephropathy develops end-stage renal disease and requires a kidney transplant. What is the primary concern regarding the transplanted kidney?
In the context of glomerular haematuria associated with IgA nephropathy, which of the following clinical scenarios would warrant the MOST aggressive immunosuppressive therapy?
In the context of glomerular haematuria associated with IgA nephropathy, which of the following clinical scenarios would warrant the MOST aggressive immunosuppressive therapy?
A 47-year-old male with a history of hypertension and recurrent haematuria is diagnosed with IgA nephropathy. Which of the following medications is MOST likely to have a renoprotective effect in this patient, independent of its blood pressure-lowering effect?
A 47-year-old male with a history of hypertension and recurrent haematuria is diagnosed with IgA nephropathy. Which of the following medications is MOST likely to have a renoprotective effect in this patient, independent of its blood pressure-lowering effect?
In a patient presenting with haematuria being evaluated for Alport's syndrome, which additional clinical finding would strongly support this diagnosis?
In a patient presenting with haematuria being evaluated for Alport's syndrome, which additional clinical finding would strongly support this diagnosis?
Microscopic examination of a urine sample reveals dysmorphic red blood cells. What does this finding suggest about the likely source of the haematuria?
Microscopic examination of a urine sample reveals dysmorphic red blood cells. What does this finding suggest about the likely source of the haematuria?
What is the Oxford MEST-C classification used for in the context of IgA nephropathy?
What is the Oxford MEST-C classification used for in the context of IgA nephropathy?
A 50-year-old man with a history of hypertension presents with microscopic haematuria and mild proteinuria. Renal biopsy shows IgA deposition in the mesangium. Which of the following Oxford MEST-C features is MOST likely to indicate a poorer long-term renal outcome?
A 50-year-old man with a history of hypertension presents with microscopic haematuria and mild proteinuria. Renal biopsy shows IgA deposition in the mesangium. Which of the following Oxford MEST-C features is MOST likely to indicate a poorer long-term renal outcome?
A 26-year-old male with a history of recurrent nephrotic syndrome since age 15 presents with increasing frequency of relapses. He is currently on prednisolone, frusemide, and spironolactone. What is the most important next step in evaluating this patient?
A 26-year-old male with a history of recurrent nephrotic syndrome since age 15 presents with increasing frequency of relapses. He is currently on prednisolone, frusemide, and spironolactone. What is the most important next step in evaluating this patient?
In the case of a 26-year-old male with long-standing nephrotic syndrome, what does the absence of haematuria suggest?
In the case of a 26-year-old male with long-standing nephrotic syndrome, what does the absence of haematuria suggest?
What is the likely primary mechanism of action of spironolactone in the management of oedema in a patient with nephrotic syndrome?
What is the likely primary mechanism of action of spironolactone in the management of oedema in a patient with nephrotic syndrome?
A 26-year-old male with nephrotic syndrome and normal blood pressure is started on an ACE inhibitor. What is the primary rationale for this intervention?
A 26-year-old male with nephrotic syndrome and normal blood pressure is started on an ACE inhibitor. What is the primary rationale for this intervention?
A patient with nephrotic syndrome has normal kidney function tests, but has significant proteinuria. What best explains the normal creatinine?
A patient with nephrotic syndrome has normal kidney function tests, but has significant proteinuria. What best explains the normal creatinine?
In a patient with nephrotic syndrome, hyperlipidemia develops, which includes hypercholesterolemia. What is the pathophysiological mechanism for this?
In a patient with nephrotic syndrome, hyperlipidemia develops, which includes hypercholesterolemia. What is the pathophysiological mechanism for this?
In a patient with nephrotic syndrome, what would indicate the need to assess for other aetiological factors?
In a patient with nephrotic syndrome, what would indicate the need to assess for other aetiological factors?
Which of the following is the most likely diagnosis given the findings show Segmental Sclerosis on renal biopsy?
Which of the following is the most likely diagnosis given the findings show Segmental Sclerosis on renal biopsy?
What is the significance of steroid-dependent focal segmental glomerulosclerosis (FSGS)?
What is the significance of steroid-dependent focal segmental glomerulosclerosis (FSGS)?
In the setting of a kidney transplant for FSGS, what is the risk of recurrence post-transplant?
In the setting of a kidney transplant for FSGS, what is the risk of recurrence post-transplant?
A 47-year-old male presents with headaches, hypertension, and pedal oedema. His history includes a recent upper respiratory tract infection (URTI). Urinalysis shows RBC +++ and protein 1+. What is the most likely underlying cause of his presentation?
A 47-year-old male presents with headaches, hypertension, and pedal oedema. His history includes a recent upper respiratory tract infection (URTI). Urinalysis shows RBC +++ and protein 1+. What is the most likely underlying cause of his presentation?
A 47-year-old patient with known hypertension and recent upper respiratory infection presents with haematuria and proteinuria. Which result would be expected?
A 47-year-old patient with known hypertension and recent upper respiratory infection presents with haematuria and proteinuria. Which result would be expected?
A patient with IgA glomerulonephritis experiences worsening renal function following an upper respiratory tract infection (URTI). What best describes the pathogenesis?
A patient with IgA glomerulonephritis experiences worsening renal function following an upper respiratory tract infection (URTI). What best describes the pathogenesis?
What is the rationale for considering the entire urinary tract, from kidney to urethra, when assessing haematuria?
What is the rationale for considering the entire urinary tract, from kidney to urethra, when assessing haematuria?
What would the presence of dysmorphic red blood cells in the urine indicate?
What would the presence of dysmorphic red blood cells in the urine indicate?
Other than Alport's syndrome, what is another cause of haematuria associated with systemic disease?
Other than Alport's syndrome, what is another cause of haematuria associated with systemic disease?
Which feature of IgA glomerulonephritis is evaluated in the Oxford scoring system?
Which feature of IgA glomerulonephritis is evaluated in the Oxford scoring system?
According to the Oxford classification of IgA nephropathy, which of the following histological findings is associated with a poorer prognosis?
According to the Oxford classification of IgA nephropathy, which of the following histological findings is associated with a poorer prognosis?
A 47-year-old male with IgA nephropathy has a renal biopsy. Which finding would suggest the need for more aggressive treatment?
A 47-year-old male with IgA nephropathy has a renal biopsy. Which finding would suggest the need for more aggressive treatment?
What would immunofluorescence show in a patient with IgA glomerulonephritis?
What would immunofluorescence show in a patient with IgA glomerulonephritis?
A 26-year-old male with recurrent swelling and proteinuria since age 15 is diagnosed with primary focal segmental glomerulosclerosis (FSGS). What is the long-term implication?
A 26-year-old male with recurrent swelling and proteinuria since age 15 is diagnosed with primary focal segmental glomerulosclerosis (FSGS). What is the long-term implication?
Which investigation is most helpful in determining the underlying pathology in a 26 year old male with recurrent swelling and proteinuria, whose creatinine levels are normal?
Which investigation is most helpful in determining the underlying pathology in a 26 year old male with recurrent swelling and proteinuria, whose creatinine levels are normal?
What is the first step in appproaching proteinuria?
What is the first step in appproaching proteinuria?
Which of the following is LEAST likely to be associated with a glomerular cause of haematuria?
Which of the following is LEAST likely to be associated with a glomerular cause of haematuria?
A 26-year-old male with nephrotic syndrome responds well to steroid treatment initially, but relapses whenever the steroid dose is tapered. What management is appropriate?
A 26-year-old male with nephrotic syndrome responds well to steroid treatment initially, but relapses whenever the steroid dose is tapered. What management is appropriate?
In a patient with nephrotic syndrome, why is U/S kidneys performed?
In a patient with nephrotic syndrome, why is U/S kidneys performed?
A 47-year-old male with IgA nephropathy has a persistent elevation in blood pressure despite being on multiple antihypertensive medications. What is the physiological mechanism that contributes to this?
A 47-year-old male with IgA nephropathy has a persistent elevation in blood pressure despite being on multiple antihypertensive medications. What is the physiological mechanism that contributes to this?
In the initial management of a 47-year-old male with IgA nephropathy, hypertension, and 1+ proteinuria, what is the most appropriate first-line treatment to reduce proteinuria and protect renal function?
In the initial management of a 47-year-old male with IgA nephropathy, hypertension, and 1+ proteinuria, what is the most appropriate first-line treatment to reduce proteinuria and protect renal function?
In the context of IgA nephropathy, what does immunofluorescence microscopy demonstrate?
In the context of IgA nephropathy, what does immunofluorescence microscopy demonstrate?
What is the commonest GN in the world?
What is the commonest GN in the world?
In the management of a patient with nephrotic syndrome, what is the key rationale for restricting dietary sodium intake?
In the management of a patient with nephrotic syndrome, what is the key rationale for restricting dietary sodium intake?
Following a renal biopsy, a 26 year old male is diagnosed with Primary focal and segmental glomerulosclerosis (FSGS). What is the treatment?
Following a renal biopsy, a 26 year old male is diagnosed with Primary focal and segmental glomerulosclerosis (FSGS). What is the treatment?
What long term implications can Primary focal and segmental glomerulosclerosis (FSGS) have?
What long term implications can Primary focal and segmental glomerulosclerosis (FSGS) have?
If a patient undergoes a kidney transplant, having been diagnosed with Primary focal and segmental glomerulosclerosis (FSGS), what is the likely outcome?
If a patient undergoes a kidney transplant, having been diagnosed with Primary focal and segmental glomerulosclerosis (FSGS), what is the likely outcome?
How can IgA glomerulonephritis aggressiveness be defined?
How can IgA glomerulonephritis aggressiveness be defined?
The presence of which Oxford scoring feature is most indicative of a poorer prognosis?
The presence of which Oxford scoring feature is most indicative of a poorer prognosis?
What stain would highlight Segmental Sclerosis?
What stain would highlight Segmental Sclerosis?
When assessing haematuria, why is it important to assess the urinary tract?
When assessing haematuria, why is it important to assess the urinary tract?
What is serum creatinine measured?
What is serum creatinine measured?
What does F.M. stain for?
What does F.M. stain for?
Flashcards
Case Presentation 1 symptoms
Case Presentation 1 symptoms
Recurrent swelling of legs and abdomen, proteinuria on dipstick urinalysis, and no haematuria.
Nephrotic Syndrome findings
Nephrotic Syndrome findings
Massive proteinuria, hypoalbuminaemia, oedema (including ascites), and hypercholesterolaemia.
Approach to Proteinuria
Approach to Proteinuria
Assess degree (nephrotic range or low level), nephritic features (BP, RBC, ARF), other system involvement, nephrotic features (albumin, lipids), and aetiological factors.
Differential Diagnosis of Nephrotic Syndrome
Differential Diagnosis of Nephrotic Syndrome
Minimal change disease, primary focal and segmental glomerulosclerosis, membranous glomerulonephritis, amyloidosis, and diabetic nephropathy.
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Treatment for Nephrotic Syndrome
Treatment for Nephrotic Syndrome
Steroids (reducing dose), ACE inhibitors, and lipid-lowering statins.
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Case Presentation 2 symptoms
Case Presentation 2 symptoms
Headaches, hypertension, and pedal oedema.
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Approach to Haematuria
Approach to Haematuria
Consider tract, glomerular causes with dysmorphic RBC's, potential systemic disease e.g. Alport's Syndrome, IgA GN, and vasculitis.
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Primary focal and segmental glomerulosclerosis
Primary focal and segmental glomerulosclerosis
Steroid responsive and steroid dependent, chronic renal failure, and may recur in transplant.
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IgA Glomerulonephritis facts
IgA Glomerulonephritis facts
Commonest GN, positive immunofluorescence, mild to aggressive.
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IgA – Oxford scoring system
IgA – Oxford scoring system
Mesangial hypercellularity, Endocapillary inflammation, Segmental sclerosis, Tubulointerstitial fibrosis, Crescents.
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What is nephrotic syndrome?
What is nephrotic syndrome?
A cluster of symptoms indicating kidney damage, characterized by proteinuria, hypoalbuminemia, edema and hyperlipidemia.
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What is proteinuria?
What is proteinuria?
The presence of an abnormally high amount of protein in the urine.
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What is Oedema?
What is Oedema?
Swelling caused by fluid accumulation in body tissues.
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What is is Glomerular hematuria?
What is is Glomerular hematuria?
The presence of blood in the urine specifically from the glomeruli.
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What is Recurrent Proteinuria?
What is Recurrent Proteinuria?
Home urine test showing recurring protein in urine.
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What does NAD mean?
What does NAD mean?
Normal findings during examination of cardiovascular, respiratory, central nervous systems.
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What does normal kidney ultrasound mean?
What does normal kidney ultrasound mean?
Normal kidney appearance.
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What is Minimal Change Disease?
What is Minimal Change Disease?
The most common cause of nephrotic syndrome in children that usually responds well to steroid treatment.
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What is glomerulosclerosis?
What is glomerulosclerosis?
A kidney disorder can destroy glomeruli and cause nephrotic syndrome.
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What is Segmental Sclerosis?
What is Segmental Sclerosis?
Condition with damage and scarring of the glomeruli that leads to nephrotic syndrome and kidney failure.
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Medical treatment to improve nephrotic syndrome?
Medical treatment to improve nephrotic syndrome?
Steroids, ACE inhibitors, lipid-lowering Statins.
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What is IgA Glomerulonephritis?
What is IgA Glomerulonephritis?
A kidney disease in which IgA immune complexes deposit in the glomeruli.
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What is Mesangial Hypercellularity?
What is Mesangial Hypercellularity?
Increase in cells within the mesangium of the kidney.
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What is Endocapillary Inflammation?
What is Endocapillary Inflammation?
Inflammation of the capillaries within an organ or tissue.
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What is Tubulointerstitial Fibrosis?
What is Tubulointerstitial Fibrosis?
Damaged kidney tubules and tissues between the kidney tubules.
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- This SGT session covered nephrotic syndrome and glomerular haematuria
Case Presentation 1: Nephrotic Syndrome
- B.S. is a 26-year-old male
- He presented with recurrent swelling of the legs and abdomen
- He had proteinuria on dipstick urinalysis, but no haematuria
- The first onset was at 15 years old
- He was diagnosed with Nephrotic Syndrome and responded well to steroids
- A biopsy was not performed
- He had recurrent courses of steroids with a good response
- Symptoms have become increasingly frequent in the last 2 years
- He is increasingly using steroids and relapses early when weaning off steroids
- He is not hypertensive
- Home dipstick tests show recurrent proteinuria, but no haematuria
- Medications include prednisolone, frusemide, and spironolactone
- His past, family, and social history are not relevant
- Examination showed +++ oedema and a BP of 110/60
- CVS, RS, and CNS were normal
- He had ascites and abdominal striae
- Urine showed protein 4+ and RBC -
- FBC, LFT, and U/E were normal
- Albumin was 27, and cholesterol was raised
- Auto antibody screen was negative
- HIV, Hep B, and Hep C were negative
- U/S kidneys showed an echogenic cortex and normal size
Summary of Findings: Case 1
- Massive proteinuria, hypoalbuminaemia, oedema including ascites, and hypercholesterolaemia are key findings
- Other findings include low/normal serum creatinine, raised creatinine filtration rate, low blood pressure, and no blood in urine
- These findings indicate nephrotic syndrome
- Creatinine clearance measured 185 ml/min (increased)
- Total Urinary Protein (TUP) was 6.87 g/24hr urine collection
- Treatment includes steroids (reducing dose), ACE inhibitors, and lipid-lowering statins
Approach to Proteinuria
- Assess the degree: nephrotic range or low level
- Additional nephritic features include BP, RBC, and ARF
- Other system involvement
- Additional nephrotic features include albumin and lipids
- Possible aetiological factors/associations include chronic infections, neoplasms, and drugs
- There are no nephritic features
- This has implications for a limited differential diagnosis
- Renal biopsy performed
- Differential diagnosis includes minimal change disease, primary focal and segmental glomerulosclerosis, membranous glomerulonephritis, amyloidosis and diabetic nephropathy
- The diagnosis was primary focal and segmental glomerulosclerosis
- It is steroid responsive and steroid dependant
- It will result in chronic renal failure
- It may recur in transplant
Case Presentation 2: Glomerular Haematuria
- N.M. is a 47-year-old male
- He presented with headaches and hypertension
- He was admitted to a peripheral hospital with severe hypertension, headache, and pedal oedema 6/52 prior to referral
- He had malaise for 2 months prior
- He takes several anti-hypertensive drugs
- He has a history of hypertension for 4 years
- He had one episode of frank haematuria in 2011 and persistent microscopic haematuria
- He has 1+ proteinuria
- Condition is Worsening with URTI
- One sister has hypertension
- His social history is not relevant
- Examination showed BP 140/90 and pedal oedema
- CVS, RS, P/A, and CNS were normal
- Urine showed RBC +++ and 1+ protein, with no organisms
- MSU negative for bacteria
- FBC, LFT, U/E were normal (serum creatinine 94)
- Auto antibody screen was normal
- Creatinine Clearance was 91ml/min (decreased)
- TUP - 1.5 g/24hr urine collection
- An Ultrasound of the kidneys was normal
- A Renal biopsy was performed
Haematuria approach
- The urinary tract from kidney to urethra is considered for causes
- Glomerular causes are associated with dysmorphic RBC's in urinalysis and may be associated with systemic disease
- Systemic diseases include Alport's Syndrome, IgA GN with HSP and Vasculitis with pulmonary renal syndrome
IgA Glomerulonephritis
- It is the commonest Glomerulonephritis in the world that requires biopsy
- It can be mild, moderately aggressive, or very aggressive.
IgA – Oxford scoring system (Classification)
- M: Mesangial hypercellularity
- E: Endocapillary inflammation
- S: Segmental sclerosis
- T: Tubulointerstitial fibrosis
- C: Crescents
- The presence of endocapillary inflammation, segmental sclerosis, advanced intertubulointerstitial fibrosis and crescents infer a poorer prognosis.
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