Asymptomatic Glomerular Hematuria Definition and Etiologies

• Hematuria • proteinuria of glomerular origin w o renal insufficiency or systemic disease

(nonglomerular hematuria more common: see "Hematuria")

• Ddx: any cause of GN, especially IgA; also consider Alport's (X-linked. deafness, renal failure) and thin basement membrane nephropathy (autosomal dominant, benign course)

IgA Nephropathy (nejm 2000.347:738.jasn 2005:16:2088) I • Most common cause of GN; male predominance w peak incidence 20-30s

• Wide range of clinical presentations: asx hematuria (30-40%). gross hematuria after URI (30-40%). chronic GN (10%). nephrotic syndrome (5%).RPGN (• 5%)

• Though clinical presentation can be highly suggestive, definitive dx only with biopsy

• Prognosis: 25-30% will reach ESRD within 20-25 y of presentation

• Treatment: ACEI ARB. • fish oils <nejm 1994:331 1194); steroids • cytotoxic therapy for crescentic GN and nephrotic syndrome, consider for progressive chronic GN

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