Rapid. Progressive Glomerulonephritis and diagnostics for it

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Hello all,

Just wondering if someone could answer this for me. My book (Lewis 10th) doesn't really go into detail.

I understand that RPGN causes rapid renal function loss, so you get edema and hypertension.

I'm assuming that you would get a UA, BUN, creatinine. As far as what to expect to be ordered as far as imaging studies, would you expect a renal ultrasound? Because anything with contrast wouldn't be filtered out correct?

I read in a few places you would get a renal biopsy, but I thought if the patient had hypertension that a biopsy would be contraindicated?

Can someone explain the use of a renal biopsy to test diagnose RPGN if the patient has hypertension?

Thank you for your time!

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Just found this on the Merck Manual.

"Early renal biopsy is essential. The feature common to all types of RPGN is focal proliferation of glomerular epithelial cells, sometimes interspersed with numerous neutrophils, that forms a crescentic cellular mass (crescents) and that fills Bowman space in > 50% of glomeruli. The glomerular tuft usually appears hypocellular and collapses. Necrosis within the tuft or involving the crescent may occur and may be the most prominent abnormality. In such patients, histologic evidence of vasculitis should be sought."

Quick edit: as plasma exchange is an key treatment for RPGN, that should help with the hypertension, right? As far as I can tell the contraindication is between biopsy and uncontrollable hypertension. I don't know much about this stuff though, just googling. Sounded like an interesting issue!

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That makes sense, thanks for your reply í ½í¸„

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