• For evaluation of elevated creatinine of unknown chronicity - start with urinalysis to look for urine sediment and renal ultrasound to look for evidence of obstruction (e.g. hydronephrosis, stones)
  
  

  Posted 12/15/16 09:46:21 AM by Anna Krigel

• Elevated BUN/Cr ratio - seen in pre-renal azotemia and obstructive disease
  Normal BUN/Cr ratio (around 10) - seen in glomerular disease
  
  

  Posted 12/15/16 09:47:00 AM by Anna Krigel

• Rapidly progressive glomerulonephritis (RPGN) 
  • clinical syndrome manifested by evidence of glomerular disease in the urine and by progressive loss of renal function over a short period of time (though no specific time period is defined)
  • characterized morphologically by extensive crescent formation
  • Usually secondary to one of three broad mechanisms of glomerular injury
    • Anti-GBM antibody disease
    • Immune complex - IgA, post-infectious , SLE
    • Pauci-immune - ANCA
  
  

  Posted 12/15/16 09:54:55 AM by Anna Krigel

• First serologic test for GN = complements!!!
  • If complements are low: SLE, postinfectious GN, MPGN, or cryoglobulinemia
  • If complements are normal: ANCA disease, anti-GBM disease, IgA nephropathy
  
  Other serologic work up: HIV, HBV, HCV, ANA, ANCAs
  
  

  Posted 12/15/16 10:08:41 AM by Anna Krigel

• ANCA-associated glomerulonephritis
  • pauci-immune GN
  • most common small vessel vasculitis in older adults
  • c-ANCA = cellular, PR3, typically associated with GPA
  • p-ANCA = perinuclear, MPO, typically associated with MPA and Churg-Strauss
  
  Induction therapy - corticosteroids + cyclophosphamide vs rituximab (RAVE trial showed non-inferiority of rituximab compared to cyclophosphamide)
  Maintenance therapy - options are azathioprine, rituximab, mycophenolate (2014 study showed rituximab is superior to azathioprine with lower rates of relapse)
  
  

  Posted 12/15/16 10:11:05 AM by Anna Krigel

• For further reading...

  RAVE trial (NEJM 2010)
  Rituximab vs azathioprine for maintenance in ANCA-associated vasculitis (NEJM 2014)
  
  

  Posted 12/15/16 10:17:55 AM by Anna Krigel

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