Diagn/Treatment

• Urinalysis: nephritic sediment

  • Hematuria (either microhematuria or intermittent macrohematuria)

  • Acanthocytes

  • Red blood cell casts: RBC casts form through the congregation of proteins and RBCs inside the tubules.

  • Mild to moderate proteinuria of > 150 mg/24 h but < 3.5 g/24 h (nonselective glomerular proteinuria)

  • Sterile pyuria and sometimes WBC casts

• Blood tests

  • ↑ Creatinine, ↓ GFR

  • Azotemia with ↑ BUN

  • Complement, ANA, ANCA, and anti-GBM antibodies

• Renal biopsy: sometimes indicated in patients with a nonspecific disease pattern to confirm diagnosis

Glomerular hematuria is a typical finding in nephritic syndrome. It is characterized by acanthocytes, RBC casts, and mild to moderate proteinuria. Nonglomerular hematuria is characterized by bright red or pink urine, the occurrence of blood clots, normal RBC morphology, and the absence of RBC casts.

• Supportive therapy

  • Low-sodium diet

  • Water restriction

• Medical therapy

  • If proteinuria and/or hypertension: angiotensin-converting enzyme inhibitors or angiotensin-receptor blockers

  • If severe hypertension and/or edema: diuretics

  • Sometimes immunosuppressive therapy is indicated (e.g., in lupus nephritis).

  • If RPGN from anti-GBM antibody disease: plasmapheresis

• In the case of:

  • Severe renal insufficiency or kidney failure: renal replacement therapy (e.g., hemodialysis, possibly transplantation)

  • Membranoproliferative glomerulonephritis (type 1 and type 2 MPGN)

    • RAAS inhibitors are often added to treatment

    • Prednisone alone or in combination with other immunosuppressants (cyclosporine OR tacrolimus)