A 65-year-old man develops oliguria and peripheral edema over a period of weeks. Urinalysis reveals hematuria and proteinuria; examination of the urinary sediment reveals red cell casts. Radiological and ultrasound studies fail to demonstrate an obstructive lesion. Renal biopsy shows many glomerular crescents. This presentation is most suggestive of which of the following conditions?
The two principal causes of rapidly progressive glomerulonephritis are anti-glomerular basement membrane (including both Goodpasture's syndrome and isolated anti-glomerular basement disease) and primary systemic vasculitis (including Wegener's granulomatosis, microscopic polyaeritis, idiopathic rapidly progressive glomerulonephritis, Churg-Strauss syndrome, polyaeritis nodosa, giant-cell aeritis, and Takayasu's aeritis). A very large variety of other systemic and primary glomerular disease may occasionally cause rapidly progressive glomerulonephritis, but this is usually not the typical presentation for these diseases. Diabetic nephropathy typically begins with microalbuminuria and hypeension and progresses over a 10 to 20 year period to renal failure. Hypeensive nephropathy due to essential hypeension typically presents with slowly rising BUN and creatinine; hypeensive nephropathy due to malignant hypeension presents with more rapidly rising BUN and creatinine. Lupus nephritis can have many presentations, but the most typical is proteinuria, which may be severe enough to cause nephrotic syndrome. Also, 90% of cases of systemic lupus erythematosus occur in women, usually of childbearing age. Ref: Lewis J.B., Neilson E.G. (2012). Chapter 283. Glomerular Diseases. In D.L. Longo, A.S. Fauci, D.L. Kasper, S.L. Hauser, J.L. Jameson, J. Loscalzo (Eds), Harrison's Principles of Internal Medicine, 18e
Anti-glomerular basement membrane disease
Diabetic nephropathy
Hypeensive nephropathy
Lupus nephritis