Last reviewed: September 2018
Last updated: August  2018

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
  • comprehensive metabolic profile
  • glomerular filtration rate (GFR)
  • full blood count
  • lipid profile
  • spot urine albumin:creatinine ratio (ACR)
  • ultrasound of kidneys
Full details

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
Full details

Treatment algorithm

Contributors

Authors VIEW ALL

Professor of Practice (Medicine)

Director of Clinical Academic Training

Imperial College London

Consultant Nephrologist

Imperial College Healthcare NHS Trust

London

UK

Disclosures

JL has received funding from Gilead for delivering and developing educational activities.

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 VIEW ALL

Department Chairman

Nephrology and Hypertension

Cleveland Clinic Foundation

Cleveland

OH

Disclosures

MS declares that he has no competing interests.

Teaching Fellow

Keele University Medical School

Keele

UK

Disclosures

PN declares that he has no competing interests.

Consultant Nephrologist

Gloucestershire Royal Hospital

Gloucester

UK

Disclosures

RB declares that he has no competing interests.

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