Glomerulonephritis/Nephrotic/Nephritic Syndrome

History:

HOPI-Swelling:

 Site, Onset, Pattern, Progression (including involvement of other sites), Aggravating and relieving factors
 Associations:
1. Frothy Urine, Hematuria, Cola colored urine, Oliguria (plus other urinary complaints)
Hypertension, Sore throat, other infections
2. Shortness of breath, Orthopnea, PND, Chest pain, Palpitation
3. Chronic Diarrhea
4. Hematemesis, Maleena, Jaundice, Abd Distension
5. Cold intolerance, Constipation
 Uremic features and Rest of Systemic Inquiry
 For Cause of NS:
 Rheumatological History plus Other Criteria of SLE if required [Serositis (Chest Pain on Deep
breath, Chest pain improving on leaning forward) Psychosis, Fits, Hematological tests, ANA,
AntiDsDNA etc.]
 Past History of DM, HBV, HCV, Solid organ malignancies, Lymphoma
 Treatment H/O NSAIDs, Gold, Penicillamine, Mercury (fairness creams), Heroin, Interferon,
Lithium, Pamidronate, Anabolic Steroids
 H/O allergy, vaccination, Insect bite (MCD)
 Congenital Hypoplasia/aplasia of kidney, Reflux nephropathy (FSGS)
 Chronic Infections e.g. TB, Chronic Arthritis (Amyloidsis)
 Features of NS Complications:
 Peritonitis, Pneumonia, Other infections
 DVT, RVT, PE
 Course of Management:
 Investigations: Creatinine, Urinalysis, 24 hrs. Urine protein, Ultrasound, Renal Biopsy etc. also
ask about previous Labs
 Treatment and its response, any relapse, H/O pulse therapy (Methyl Prednisolone,
Cyclophosphamide)
 Dialysis, Plasmapheresis, Any H/O of their complications
 Drugs Complications:
 Diuretic: Postural dizziness, Increased Thirst
 Steroids: Proximal muscle weakness e.g. on combing hair, climbing stairs, Wt. Gain, Epigastric
pain, Acne, AVN of Hip joints
 CNI: Tremors, Hypertrichosis, Gum hypertrophy
 MMF: Abd pain, Nausea, Vomiting, Diarrhea
 Cyclophosphamide: Hematuria, Infertility
 Rest of Past History; Family and Personal History

Examination:
 Muehrcke’s Lines, Xanthelasma, Xanthoma, Skin Rash
 In male patient of Nephrotic syndrome, palpate scrotum for varicocele.
 Perform Rheumatological Examination in patients with RA and SLE (in case of joint involvement).
 Look for cushingoid features, acne, striae and proximal muscle weakness for steroid toxicity.