8/17 Morning Report w/ Morgan: The nephritic/nephrotic spectrum

An older female w/ HCV p/w shortness of breath and volume overload, found to have proteinuria, hyertension, and hypoalbuminemia. Urine sediment showed  dysmorphic reds, and complement levels were low. The diagnosis of GN with nephrotic features was made, thought likely 2/2 MPGN given her history of untreated HCV and complement levels; final results of a renal biopsy are pending.
Main Teaching Point:
Nephritic/Nephrotic syndromes represent a spectrum of disease. The syndromes that most often present with both nephrotic and nephritic features include MPGN, membranoproliferative glomerulonephropathy, and lupus nephritis. Generally, the mixed syndromes are the most severe  – exceptions include RPGN (mostly nephritic) and HIV nephropathy, which both can quickly progress to ESRD.
Inline image 1
Other pearls:
*When you want to estimate CVP and can’t see the IJ:
-The EJ has been validated as a reliable surrogate (Vanayak AG et al. “Usefulness of the external jugular vein examination in detecting abnormal central venous pressure in critically ill patients”. Arch Intern Med 2006.)
– Hand raise (watch for hand veins to flatten as you lift arm towards heart level)
– Ultrasound to look at IJ or IVC

Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out /  Change )

Google photo

You are commenting using your Google account. Log Out /  Change )

Twitter picture

You are commenting using your Twitter account. Log Out /  Change )

Facebook photo

You are commenting using your Facebook account. Log Out /  Change )

Connecting to %s