Rapidly progressive glomerulonephritis physical examination

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Ahmed Elsaiey, MBBCH [2] Nazia Fuad M.D.

Overview

Common physical examination findings of rapidly progressive glomerulonephritis include, hematuria, hypertension, edema, skin nodules, gastrointestinal bleeding.

Arthralgia and arthritis may be seen. Nervous system involvement is present in 30% of patients with microscopic polyangiitis and 70% of patients with Churg-Strauss diseas.

Physical examination

Appearance of the patient

Patients with rapidly progressive glomerulonephritis usually appear ill.
Patient may appear pale due to anemia.

Vital signs

Hypertension

Skin

Erythematous nodules due to necrotizing arteritis^[1]
Granulomatous cutaneous nodules in patients presening with granulomatosis with polyangitis

Abdomen

Most of patients with ANCA +ve shows gastrointestinal involvement^[2]
Occult GI bleeding as a result of ulceration due to arteritis
Pancreatitis may be present with following signs
- Abdominal pain radiating to back
- Fever
- Tachycardia
- Weight loss
- Steatorrhea

Neuromuscular

Mononeuritis multiplex in ANCA +ve patients^[3]
Arthritis
Arthralgia

Genitourinary

Hematuria

Penile/vaginal discharge

Neuromuscular

Mononeuritis multiplex in ANCA +ve patients^[3]
Arthritis
Arthralgia
Generalized seizures

Patient is usually oriented to persons, place, and time.

Extremities

Pitting/non-pitting edema of the upper/lower extremities

References

↑ Daoud MS, Gibson LE, DeRemee RA, Specks U, el-Azhary RA, Su WP (October 1994). “Cutaneous Wegener’s granulomatosis: clinical, histopathologic, and immunopathologic features of thirty patients”. J. Am. Acad. Dermatol. 31 (4): 605–12. PMID 8089286.
↑ Pagnoux C, Mahr A, Cohen P, Guillevin L (March 2005). “Presentation and outcome of gastrointestinal involvement in systemic necrotizing vasculitides: analysis of 62 patients with polyarteritis nodosa, microscopic polyangiitis, Wegener granulomatosis, Churg-Strauss syndrome, or rheumatoid arthritis-associated vasculitis”. Medicine (Baltimore). 84 (2): 115–28. PMID 15758841.
↑ ^3.0 ^3.1 Anadure R, Narayanan C, Varadraj G, Nandeesh B (January 2017). “ANCA Associated Mononeuritis Multiplex with Overlap in Vasculitic Syndromes”. J Clin Diagn Res. 11 (1): OD01–OD03. doi:10.7860/JCDR/2017/22252.9149. PMC 5324437. PMID 28273992.

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[pmid8089286-1] Daoud MS, Gibson LE, DeRemee RA, Specks U, el-Azhary RA, Su WP (October 1994). “Cutaneous Wegener’s granulomatosis: clinical, histopathologic, and immunopathologic features of thirty patients”. J. Am. Acad. Dermatol. 31 (4): 605–12. PMID 8089286.

[pmid15758841-2] Pagnoux C, Mahr A, Cohen P, Guillevin L (March 2005). “Presentation and outcome of gastrointestinal involvement in systemic necrotizing vasculitides: analysis of 62 patients with polyarteritis nodosa, microscopic polyangiitis, Wegener granulomatosis, Churg-Strauss syndrome, or rheumatoid arthritis-associated vasculitis”. Medicine (Baltimore). 84 (2): 115–28. PMID 15758841.

[pmid28273992-3] 3.0 ^3.1 Anadure R, Narayanan C, Varadraj G, Nandeesh B (January 2017). “ANCA Associated Mononeuritis Multiplex with Overlap in Vasculitic Syndromes”. J Clin Diagn Res. 11 (1): OD01–OD03. doi:10.7860/JCDR/2017/22252.9149. PMC 5324437. PMID 28273992.

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