Rapidly progressive glomerulonephritis physical examination: Difference between revisions
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__NOTOC__ | __NOTOC__ | ||
{{Rapidly progressive glomerulonephritis}} | {{Rapidly progressive glomerulonephritis}} | ||
{{CMG}}; {{AE}} {{AEL}} | {{CMG}}; {{AE}} {{AEL}} {{N.F}} | ||
==Overview== | ==Overview== | ||
Common physical examination findings of rapidly progressive glomerulonephritis include, [[hematuria]], [[hypertension]], [[edema]], [[skin nodules]], gastrointestinal bleeding. | |||
[[Arthralgia]] and [[arthritis]] may be seen. Nervous system involvement is present in 30% of patients with microscopic polyangiitis and 70% of patients with [[Churg-Strauss syndrome|Churg-Strauss diseas]]. | |||
==Physical examination== | ==Physical examination== | ||
===Appearance of the patient=== | ===Appearance of the patient=== | ||
* Patients with rapidly progressive glomerulonephritis usually appear ill. | * Patients with rapidly progressive glomerulonephritis usually appear ill. | ||
* Patient may appear pale due to [[anemia.]] | |||
===Vital signs=== | ===Vital signs=== | ||
* | * [[Hypertension]] | ||
===Skin=== | ===Skin=== | ||
* | * [[Erythematous]] nodules due to [[necrotizing arteritis|necrotizing]] arteritis<ref name="pmid8089286">{{cite journal |vauthors=Daoud MS, Gibson LE, DeRemee RA, Specks U, el-Azhary RA, Su WP |title=Cutaneous Wegener's granulomatosis: clinical, histopathologic, and immunopathologic features of thirty patients |journal=J. Am. Acad. Dermatol. |volume=31 |issue=4 |pages=605–12 |date=October 1994 |pmid=8089286 |doi= |url=}}</ref> | ||
* Granulomatous cutaneous nodules in patients presening with granulomatosis with polyangitis | |||
* Granulomatous cutaneous nodules in patients | |||
===Abdomen=== | ===Abdomen=== | ||
* Most of patients with ANCA +ve shows gastrointestinal involvement<ref name="pmid15758841">{{cite journal |vauthors=Pagnoux C, Mahr A, Cohen P, Guillevin L |title=Presentation and outcome of gastrointestinal involvement in systemic necrotizing vasculitides: analysis of 62 patients with polyarteritis nodosa, microscopic polyangiitis, Wegener granulomatosis, Churg-Strauss syndrome, or rheumatoid arthritis-associated vasculitis |journal=Medicine (Baltimore) |volume=84 |issue=2 |pages=115–28 |date=March 2005 |pmid=15758841 |doi= |url=}}</ref> | * Most of patients with [[Anti-neutrophil cytoplasmic antibody|ANCA]] +ve shows gastrointestinal involvement<ref name="pmid15758841">{{cite journal |vauthors=Pagnoux C, Mahr A, Cohen P, Guillevin L |title=Presentation and outcome of gastrointestinal involvement in systemic necrotizing vasculitides: analysis of 62 patients with polyarteritis nodosa, microscopic polyangiitis, Wegener granulomatosis, Churg-Strauss syndrome, or rheumatoid arthritis-associated vasculitis |journal=Medicine (Baltimore) |volume=84 |issue=2 |pages=115–28 |date=March 2005 |pmid=15758841 |doi= |url=}}</ref> | ||
* Occult GI bleeding as a result of ulceration due to arteritis | * [[Occult bleeding|Occult]] GI bleeding as a result of [[ulceration]] due to [[arteritis]] | ||
* Pancreatitis may be present | * [[Pancreatitis]] may be present with following signs | ||
** Abdominal pain radiating to back | |||
** Fever | |||
** [[Tachycardia]] | |||
** Weight loss | |||
** [[Steatorrhea]] | |||
===Neuromuscular=== | ===Neuromuscular=== | ||
* Mononeuritis multiplex in ANCA +ve patients<ref name="pmid28273992">{{cite journal |vauthors=Anadure R, Narayanan C, Varadraj G, Nandeesh B |title=ANCA Associated Mononeuritis Multiplex with Overlap in Vasculitic Syndromes |journal=J Clin Diagn Res |volume=11 |issue=1 |pages=OD01–OD03 |date=January 2017 |pmid=28273992 |pmc=5324437 |doi=10.7860/JCDR/2017/22252.9149 |url=}}</ref> | * [[Mononeuritis multiplex]] in [[Anti-neutrophil cytoplasmic antibody|ANCA]] +ve patients<ref name="pmid28273992">{{cite journal |vauthors=Anadure R, Narayanan C, Varadraj G, Nandeesh B |title=ANCA Associated Mononeuritis Multiplex with Overlap in Vasculitic Syndromes |journal=J Clin Diagn Res |volume=11 |issue=1 |pages=OD01–OD03 |date=January 2017 |pmid=28273992 |pmc=5324437 |doi=10.7860/JCDR/2017/22252.9149 |url=}}</ref> | ||
* Arthritis | * [[Arthritis]] | ||
* Arthralgia | * [[Arthralgia]] | ||
===Genitourinary === | ===Genitourinary === | ||
* Hematuria | * [[Hematuria]] | ||
* Penile/vaginal discharge | |||
=== Neuromuscular === | |||
* [[Mononeuritis multiplex]] in [[Anti-neutrophil cytoplasmic antibody|ANCA]] +ve patients<ref name="pmid28273992" /> | |||
* [[Arthritis]] | |||
* [[Arthralgia]] | |||
* Generalized [[Seizure|seizures]] | |||
* Patient is usually oriented to persons, place, and time. | |||
=== Extremities === | |||
* Pitting/non-pitting [[edema]] of the upper/lower extremities | |||
==References== | ==References== | ||
Latest revision as of 13:35, 31 July 2018
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Ahmed Elsaiey, MBBCH [2] Nazia Fuad M.D.
Overview
Common physical examination findings of rapidly progressive glomerulonephritis include, hematuria, hypertension, edema, skin nodules, gastrointestinal bleeding.
Arthralgia and arthritis may be seen. Nervous system involvement is present in 30% of patients with microscopic polyangiitis and 70% of patients with Churg-Strauss diseas.
Physical examination
Appearance of the patient
- Patients with rapidly progressive glomerulonephritis usually appear ill.
- Patient may appear pale due to anemia.
Vital signs
Skin
- Erythematous nodules due to necrotizing arteritis[1]
- Granulomatous cutaneous nodules in patients presening with granulomatosis with polyangitis
Abdomen
- Most of patients with ANCA +ve shows gastrointestinal involvement[2]
- Occult GI bleeding as a result of ulceration due to arteritis
- Pancreatitis may be present with following signs
- Abdominal pain radiating to back
- Fever
- Tachycardia
- Weight loss
- Steatorrhea
Neuromuscular
- Mononeuritis multiplex in ANCA +ve patients[3]
- Arthritis
- Arthralgia
Genitourinary
- Penile/vaginal discharge
Neuromuscular
- Mononeuritis multiplex in ANCA +ve patients[3]
- Arthritis
- Arthralgia
- Generalized seizures
- Patient is usually oriented to persons, place, and time.
Extremities
- Pitting/non-pitting edema of the upper/lower extremities
References
- ↑ Daoud MS, Gibson LE, DeRemee RA, Specks U, el-Azhary RA, Su WP (October 1994). "Cutaneous Wegener's granulomatosis: clinical, histopathologic, and immunopathologic features of thirty patients". J. Am. Acad. Dermatol. 31 (4): 605–12. PMID 8089286.
- ↑ Pagnoux C, Mahr A, Cohen P, Guillevin L (March 2005). "Presentation and outcome of gastrointestinal involvement in systemic necrotizing vasculitides: analysis of 62 patients with polyarteritis nodosa, microscopic polyangiitis, Wegener granulomatosis, Churg-Strauss syndrome, or rheumatoid arthritis-associated vasculitis". Medicine (Baltimore). 84 (2): 115–28. PMID 15758841.
- ↑ 3.0 3.1 Anadure R, Narayanan C, Varadraj G, Nandeesh B (January 2017). "ANCA Associated Mononeuritis Multiplex with Overlap in Vasculitic Syndromes". J Clin Diagn Res. 11 (1): OD01–OD03. doi:10.7860/JCDR/2017/22252.9149. PMC 5324437. PMID 28273992.