Diffuse Proliferative Glomerulonephritis Clinical Presentation
- Author: Moro O Salifu, MD, MPH, FACP; Chief Editor: Vecihi Batuman, MD, FACP, FASN more...
Focus the history on the causes of DPGN and the associated symptoms. While a minority of patients may be asymptomatic (ie, < 15%) and are diagnosed during routine laboratory examination, most patients manifest signs of the primary disease as well as those relating to renal injury.
- Suspect DPGN in patients with SLE, infectious disease processes, a recent streptococcal throat infection, or in patients with sinopulmonary disease who have recent onset of the following:
- Microscopic or gross hematuria
- Nonnephrotic or nephrotic range proteinuria or an increase in proteinuria from baseline
- Serum creatinine of more than 0.4 mg/dL from the reference range or the baseline
- Oligoanuria and symptoms of uremia in severe cases of RPGN with crescent formation
- Also suspect DPGN in a patient with other systemic diseases who has recent onset of the same findings listed above.
- Nonspecific symptoms, including nausea, vomiting, fatigue, or weight loss may indicate uremia or symptoms of the primary disease process.
- A history of rash; photosensitivity; oral ulcers; arthralgias; arthritis; serositis; or a renal, neurologic, hematologic, or immunologic disorder suggests SLE as the primary disease.
- A history of cough, dyspnea, hemoptysis, and renal disease suggests Goodpasture syndrome, but other pulmonary-renal syndromes must be ruled out, including SLE pneumonitis, Wegener granulomatosis, cryoglobulinemia, renal vein thrombosis with pulmonary embolism, legionella infection, and congestive heart failure.
- Patients with Wegener granulomatosis present with sinopulmonary disease (ie, paranasal sinus pain and drainage with purulent or bloody nasal discharge and occasional nasal mucosal ulceration/perforation, leading to saddle nose deformity), serous otitis media (ie, blockage of the eustachian tube), cough, dyspnea, and hemoptysis.
- Patients with IgA nephropathy (ie, Berger disease) may present with the classic findings of flank pain and gross hematuria following upper respiratory infections. Others may simply have indolent microhematuria found incidentally. Much less commonly, patients present with acute glomerulonephritis, renal failure, and nephrotic syndrome.
See the list below:
- If azotemia is present, exclude prerenal and postrenal causes.
- Nonspecific findings that suggest DPGN
- Fever, present in infectious and noninfectious glomerulonephritis
- Findings pertaining to SLE include the often acute onset of conjunctivitis, episcleritis, photosensitivity, oral ulcers, malar rash (eg, erythema of the nose and malar eminences in a butterfly distribution), discoid lupus, pleural or pericardial friction rub, psychosis, seizures, nonerosive arthritis, or arthralgia
- Findings relating to pauci-immune disease (eg, anti-GBM disease, Wegener granulomatosis) and Goodpasture syndrome
- Sinusitis, otitis, saddle nose deformity, hemoptysis
- Lung consolidation, which suggests pulmonary hemorrhage
- Findings relating to IgA nephropathy (usually postinfectious) and other infectious glomerulonephritis
- Pharyngitis, gastroenteritis
- Impetigo, which is the most common cause of poststreptococcal glomerulonephritis worldwide
See the list below:
- Immunoglobulin A (IgA) nephropathy and SLE are the most common causes. Other etiologies are less frequent but are more likely to lead to RPGN.
- Systemic diseases
- Lupus nephritis class IV, IgA nephropathy
- Goodpasture syndrome, Wegener granulomatosis, microscopic polyangiitis, Henoch-Schönlein purpura
- Cryoglobulinemia, vasculitis
- Infectious causes
- Poststreptococcal glomerulonephritis, which occurs 2-4 weeks after streptococcal sore throat or skin infection
- Infective endocarditis, hepatitis B, hepatitis C
- Histologic transformation
- In patients with class IV lupus nephritis, histologic transformation from one class to another is recorded in up to 40% of repeat biopsies.
- The most likely transformation is from class II or III to class IV. Any other class may be superimposed on class V.
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