Rapidly progressive glomerulonephritis diagnostic study of choice

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Ali Poyan Mehr, M.D. [2] Associate Editor(s)-in-Chief: Krzysztof Wierzbicki M.D. [3], Amandeep Singh M.D.[4],

Ahmed Elsaiey, MBBCH [5], Nazia Fuad M.D.

Rapid diagnosis of rapidly progressive glomerulonephritis is very crucial to save kidneys function. It includes blood workup and renal biopsy.Renal biopsy will provide the definitive diagnosis about the extent of involvement. Sometimes the result can be delayed ,in such cases the emperative therapy should be started to prevent end stage renal disease.

• Renal biopsy will provide the most accurate reslt.
• Renal biopsy will give accurate information about the extent of the disease and therapy can be planned accordingly.

• Findings include:^[1]
  • Diffuse inflammation in glomeruli with rupture and damage to glomerular basement membrane.
  • Crescents are present in the Bowmans space.
  • Renal vessels can show transmural vasculitis, with necrosis and lymphocyte infiltrates.
  • Tubular necrosis may also be present.
  • Interstitial granulomas in the glomeruli indicate Wegener’s granulomatosis.

• In type I RPGN- diffuse and linear deposition of IgG along the GBM.
• In ttype II RPGN- diffuse and irregular deposition of IgG and C3 in the mesangial matrix.
• In type III RPGN- no finding.
• Electron microscopy
• In type I and type III, no electron dense deposits are seen.
  • In type II RPGN, subepithelial electron dense deposits indiacting the presence of immune complexes are seen.

• Complete blood cell count (CBC) withdifferential,
  • Anemia can be seen in patienst with renal failure or gastrointestinal tract bleeding.
  • Eosinophilia greater than 13% suggest Churg-Strauss disease.
• Serum electrolytes
• BUN(blood urea nitrogen)
• Serum creatinine
• Lactate dehydrogenase (LDH)
• Creatine phosphokinase (CPK),
• The most common abnormality is an increased serum creatinine level
• Urinalysis with microscopy: Proteinuria equal to or greater than 2-3 g in 24 hours.
• Microscopic hematuria
• Red cell casts indicates glomerular inflammation
• Erythrocyte sedimentation, elevated with active disease.
• C-reactive protein: levels are elevated and correspond with disease activity.
• Antinuclear antibody (ANA).High ANA titer is present in systemic lupus erythematosus.

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