Summary
Definition
History and exam
Key diagnostic factors
- presence of risk factors
- haematuria
- oedema
- hypertension
Other diagnostic factors
- oliguria
- anorexia
- nausea
- malaise
- weight loss
- fever
- skin rash
- arthralgia
- haemoptysis
- abdominal pain
- sore throat
- hypervolaemia
Risk factors
- group A beta-haemolytic Streptococcus
- respiratory infections
- gastrointestinal infections
- hepatitis B
- hepatitis C
- infective endocarditis
- HIV
- systemic lupus erythematosus (SLE)
- systemic vasculitis
- Hodgkin's lymphoma
- lung cancer
- colorectal cancer
- non-Hodgkin's lymphoma
- leukaemia
- thymoma
- haemolytic uraemic syndrome
- drugs
Diagnostic investigations
1st investigations to order
- urinalysis and urine microscopy
- comprehensive metabolic profile
- glomerular filtration rate (GFR)
- full blood count
- lipid profile
- spot urine albumin:creatinine ratio (ACR)
- ultrasound of kidneys
Investigations to consider
- erythrocyte sedimentation rate (ESR) or C-reactive protein (CRP)
- complement levels
- rheumatoid factor
- anti-neutrophil cytoplasmic antibody
- anti-glomerular basement membrane (GBM) antibody
- antistreptolysin O antibody
- antihyaluronidase
- anti-DNase
- anti-double-stranded DNA
- antinuclear antibody
- cryoglobulins
- hepatitis C virus and hepatitis B serology
- HIV serology
- electrophoresis
- drug screen
- renal biopsy
- antiphospholipase A2 receptor antibodies
- computed tomographic scan of chest and abdomen
Treatment algorithm
mild disease
moderate-severe disease
rapidly progressive
persistent haematuria, proteinuria, or reduced GFR
Contributors
Authors
Jeremy Levy, MA, PhD, DSc (Hon), FHEA, FRCP
Professor of Practice (Medicine)
Director of Clinical Academic Training
Imperial College London
Consultant Nephrologist
Imperial College Healthcare NHS Trust
London
UK
Disclosures
JL declares that he has no competing interests.
Acknowledgements
Dr Jeremy Levy would like to gratefully acknowledge Dr Padmanabhan Premkumar, Dr Priyanka Sharma, and Dr Ajay Kumar, previous contributors to this topic. PP, PS, and AK declare that they have no competing interests.
Peer reviewers
Martin Schreiber, MD
Department Chairman
Nephrology and Hypertension
Cleveland Clinic Foundation
Cleveland
OH
Disclosures
MS declares that he has no competing interests.
Patrick Naish, MB, FRCP
Teaching Fellow
Keele University Medical School
Keele
UK
Disclosures
PN declares that he has no competing interests.
Richard Banks, MBBS, FRCP, MD
Consultant Nephrologist
Gloucestershire Royal Hospital
Gloucester
UK
Disclosures
RB declares that he has no competing interests.
Differentials
- Nephrolithiasis
- Bladder cancer
- Renal cancer
More DifferentialsGuidelines
- KDIGO clinical practice guideline for glomerular diseases
- Evidence-based clinical practice guidelines for rapidly progressive glomerulonephritis 2014
More GuidelinesPatient leaflets
Glomerulonephritis
Kidney infection
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