REBOOT #250 Nephrotic Syndrome vs. Glomerulonephritis with Kidney Boy, Dr. Joel Topf
Dec 11, 2023
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Dr. Joel Topf, Kashlak's esteemed Chief of Nephrology, discusses the evaluation and differentiation of nephrotic syndrome and glomerulonephritis. Topics include proteinuria evaluation, management of nephrotic syndrome, and treatment of glomerulonephritis.
Differentiate nephrotic syndrome and glomerulonephritis based on clinical presentation and diagnostic tests.
Manage proteinuria in nephrotic syndrome with loop diuretics and statins, and control hypertension.
Diagnose and treat glomerulonephritis based on specific clinical scenarios and renal biopsy findings.
Deep dives
The presentation of GN
The patient presents with acute kidney injury, hypertension, hematuria, and proteinuria, indicating glomerulonephritis.
Possible causes of GN
The differential diagnosis includes post-infectious GN, ANCA-associated small vessel vasculitis, anti-glomerular basement membrane disease, immune complex GN like lupus nephritis, and others.
Further workup and considerations
The patient's urine microscopy reveals dysmorphic red blood cells and granular casts. The presence of a friction rub suggests possible lupus nephritis. Additional investigations may include autoimmune serology, renal biopsy, and assessment of systemic symptoms or other organ involvement.
Overview of Nephrotic Syndrome and Glomerular Diseases
Nephrotic syndrome is characterized by heavy proteinuria, and a protein-creatinine ratio greater than two grams in 24 hours warrants further investigation. It is important to check the urine for proteinuria and quantify it using a protein-creatinine or albumin-creatinine ratio. Anti-PLA2R is a valuable marker for diagnosing and monitoring memranous nephropathy. Loop diuretics and statins are used to manage proteinuria in patients with minimal change disease, focal segmental glomerulosclerosis, or diabetes. Hypertension control is crucial, and anticoagulation may be considered in patients with low albumin levels.
Approach to Nephritic Syndrome and Lupus Nephritis
Patients with nephritic syndrome, characterized by acute kidney injury, hematuria, and hypertension, require a renal biopsy for diagnosis. Lupus nephritis is commonly managed with mycophenolate mofetil, cyclophosphamide, and steroids. Anti-PLA2R can be used for diagnosing primary membranous nephropathy. Treatment options for IgA nephropathy, ANCA-associated GN, and Goodpasture's syndrome include steroids, rituximab, or plasma exchange, depending on the specific clinical scenario. Low complement levels are seen in lupus nephritis, idiopathic membranous GN, post-infectious GN, and cryoglobulinemic-associated GN.
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Kashlak’s esteemed Chief of Nephrology, Dr Joel Topf @kidney_boy walks us through the evaluation and differentiation of nephrotic syndrome and glomerulonephritis. Embrace the kidney again as we sort the different diagnostics, managements, and prognosis for these two pathologies.