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Nephritic vs Nephrotic Syndrome Step 1: If the patient has hematuria and/or proteinuria, think about nephrotic/nephritic syndromes. Step
Nephritic vs Nephrotic Syndrome ... nephrotic/nephritic syndromes ... glomerular hematuria (RBC ... or dysmorphic RBCs ... Nephritic #Nephrotic #Syndrome
Red Blood Cell (RBC) Morphology Microcytic RBC: Pyridoxine deficiency, Thalassemia, Iron deficiency anemia, Chronic disease anemia (sometimes),
Red Blood Cell (RBC ... Morphology Microcytic RBC ... phenotype, Post-splenectomy ... Bite Cell RBC: G6PD ... Hemoglobinopathies, Post-splenectomy
Red Blood Cell (RBC) Morphology Atlas • Microcytic - Iron-deficiency anemia, Thalassemia, Sideroblastic anemia, Lead poisoning
Red Blood Cell (RBC ... Myelodysplastic syndrome ... intoxication, Post-splenectomy ... Hemolytic uremic syndrome ... coagulopathy (DIC) #RBC
Common RBC Inclusions and Associations • Howell Jolly Bodies: Hyposplenism, Asplenism, Severe hemolytic anemia • Heinz
Common RBC Inclusions ... Hemolytic anemia, Post-splenectomy ... Sickle cell, MDS #RBC
Warm Antibody Autoimmune Hemolytic Anemia 1) DIAGNOSE AIHA • Anemia: macrocytic > normocytic, ↑ reticulocytes •
↑ LDH • Anti-RBC ... Rituximab +++ 3 - Splenectomy
Glomerular Diseases - Nephritic and Nephrotic Syndromes Nephritic syndrome—due to GBM disruption. Hypertension. t BUN and creatinine.
and Nephrotic Syndromes ... Nephritic syndrome—due ... RBC casts in urine ... Nephrotic yndrome—podocyte ... Nephritic #Nephrotic #Syndromes
Hemolysis - Differential Diagnosis Framework 1) Environment - Fragmentation - MAHA: TTP, HUS, DIC, HELLP
2) External (RBC ... Drug-associated, PCH, Evans Syndrome ... 3) Internal (RBC ... Smear ↑ abnormal RBCs
Causes of Thrombocytosis - Differential Diagnosis Algorithm Spurious: • Artifact (redo CBC) Autonomous: • Essential thrombocytosis • Polycythemia
Artifact (redo CBC ... Other: • Post-splenectomy
Pulmonary Renal Syndrome Definition: Diffuse alveolar hemorrhage + Glomerulonephritis Presentation (Pulmonary and renal manifestations can occur weeks apart):
Pulmonary Renal Syndrome ... Pulmonary Renal Syndromes ... Infection, Alport Syndrome ... Investigations • Labs: CBC ... proteinuria, dysmorphic RBCs
Causes of Proteinuria - Differential Diagnosis Algorithm Persistent Proteinuria >150mg/d protein present on repeat testing including overnight
• Fanconi's syndrome ... urine sediment - WBC ... /RBC casts
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