#rpgn

RPGN is a GN you don't want to miss since, as the name suggest, the progression is quite rapid (anything from months to days). So when the alarm bells go off in your head and your inner voice is screaming "fuck, fuck, fuck, fuck", maintain a professional exterior and think F, F, F, F:

symptom progression in RPGN:

Flu-like symptoms

Falling GFR (with nephritic syndrome - Hematuria, increased BP and moderate proteinuria)

Failure (acute oliguric renal failure) 

Fluid overload

If the symptoms fit or seem suspicious and your inner voice starts screaming "ass, ass, ass, ass", maintain a professional exterior and think A, A, A, A:

Blood screening for:

Anti-GBM-ab = Goodpasture 

ANA and anti-DNA = SLE

Acute renal failure = elevated creatinine, urea and potassium

ANCA

PR3-ANCA = Wegener's (a W has 3 "tops"),

MPO-ANCA = Microscopic Polyangiitis (MPO = MPA),

MPO-ANCA + eosinophilia = Churg-Strauss (2 markers = 2 names)

When symptoms, blood-work and biopsy all point to RPGN and your inner voice starts screaming "cunt, cunt, cunt, cunt" maintain a professional exterior and think C, C, C, C:

Progression of treatment:

Corticosteroids (immunosuppression to halt cell proliferation)

Cyclophosphamide (immunosuppression to halt cell proliferation)

Chronic dialysis (to avoid azotemia or to remove immunocomplexes via plasmapheresis)

Call a surgeon (transplantation)

Background information:

Goodpasture's Syndrome

autoimmune condition characterised by anti-GBM (glomerular basement membrane) antibodies

antibodies are directed against type IV collagen

classically produces a pulmonary-renal syndrome

Features; haemoptysis, dyspnoea, pulmonary haemorrhage, rapidly progressing glomerulonephritis (haematuria, red cell casts, proteinuria, loss of kidney function)