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RPGN - Rapidly Progressive Acute Renal Failure (over weeks)
Two ways to approach Differential
Demographics
Complement
- Low complement
- Peri- infectious; strep and staph (endocarditis)
- lupus
- Cryo
- MPGN
- Normal complements
- IGA (immune complex but slow/chronic so liver could produce complements to compensate)
- Can cause vasculitis with abdominal pain and rash (Henoch-Schonlen Purpura)
- ANCA
- Anti-GBM
Drugs like PPI unlikely to cause such a rapid change in Cr with interstitial nephritis
Posted 04/06/17 09:18:58 AM by Ying Liu
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Clinical Pearls
- Would expect hypertension with RPGN
- Another way to rule out alvelolar hemmorhage is PFTs and look for DLCO that is not normal
- If on HD for more than 3 months, renal recovery is unlikely and want to reduce immunosuppression given HD
- Cr above 7 (woman) and 10 (man) renal recovery is unlikely, especially if anuric
Posted 04/06/17 09:19:55 AM by Ying Liu
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Rituxumab vs cyclophosphamide for ANCA and Anti-GBM Disease
- 2 trials
- Jones et al. studied more severe disease and both groups (rituxumab and Cyclophosphamide) got at least 2 doses of cyclophosphamide. No differences between groups
- Stone et al. studied a group with less severe disease and rituxumab group was non-inferior to cyclophosphamide group
- In women of reproductive age, cyclophosphamide affects feritility (dependent on age, not an issue until 20-21 and then is dose dependent)
- Data for rituxumab for anti GBM is very scarce and cyclophosphamide is first line (cyclophosphamide kils Tregs faster than rituxumab can deplete B cells). Often will use oral cyclophosphamide for faster load
- Plasmapharesis to get rid of the antibodies is the best way to treat anti GBM
Posted 04/06/17 09:51:28 AM by Ying Liu
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For further reading...
Posted 04/06/17 09:51:48 AM by Ying Liu
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For further reading...
Posted 04/06/17 09:52:03 AM by Ying Liu
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