Wegener’s/How to Spin Urine 101

What is your differential diagnosis for a 40 yo M who presents with acute glomerulonephritis? If you guessed “Wegener’s granulomatosis but patient did not tell medical team that he had this existing diagnosis,” you would be correct!

On your differential for RPGN (rapidly progressive glomerulonephritis), 2 disorders cannot be forgotten:

• ANCA-associated granulomatous vasculitis
• Goodpasture’s Disease

When spinning urine and looking for evidence of glomerulonephritis, please remember that RBC casts will often break down after 1 hour of the urine’s collection.  However, you can still see dysmorphic RBCs under the microscope.

And finally, our patient had side effects from cyclophosphamide in the past and therefore will be started on rituximab for treatment of Wegener’s. The RAVE trial was done with huge input from the faculty in the Rheumatology department and was published in the NEJM in 2010.

• N Engl J Med 2010; 363:221-232

And finally, here are the Powerpoint slides from today’s presentation:

• Wegener’s Granulomatosis