12/16/16 Intern Morning Report – ANCA Vasculitis, Necrotizing Glomerulonephritis

CC: 2 weeks of bilateral lower extremity edema

ID: 59 yo female with no medical history presents with 2 weeks of bilateral lower extremity edema.  She initially presented to OSH for evaluation, was told she had a “kidney infection,” and was treated with ampicillin.  Shortly after, she developed a rash and bilateral upper extremity edema, prompting presentation to our hospital.  Upon admission, she was found to have renal failure with a BUN of 161 and Cr of 8.34.  UA revealed + blood, + protein, along with normal complement levels.  She was found to be p-ANCA positive with high titers of the MPO antibody.  A skin biopsy of the rash revealed a hypersensitivity reaction and the renal biopsy demonstrated necrotic tissue, consistent with ANCA vasculitis.

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Pearls from morning report:

  • SLE can present as nephrotic, nephritic, or mixed pattern.  It usually starts as a nephritic pattern and progresses to a nephrotic pattern.  The nephrotic pattern is by far the most commonly presented pattern.
  • Rapidly Progressive Glomerulonephritis (RPGN) is a clinical syndrome characterized by acute onset of macroscopic hematuria, decreased urine output, and edema, though commonly, it can present insidiously with symptoms of fatigue or edema.  The most common processes causing RPGN are anti-GBM disease, pauci-immune/ANCA GN. and immune complex GN.
  • Common organisms implicated in Infection-related GN include Staphylococcus and Streptococcus.

Random trivia:

Actor/director Harold Ramis, who played Egon Spengler in Ghostbusters, passed away from complications of ANCA vasculitis.


Want to read more?

Glomerulonephritis (New England Journal of Medicine)
Nephrotic Syndrome (New England Journal of Medicine)


References: 

Jennette JC. Rapidly progressive crescentic glomerulonephritis. Kidney Int. 2003;63(3):1164-77.

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