Patient: [Patient Name]
MRN: [Medical Record Number]
Date: [Date of Encounter]
Chief Complaint:
New or follow-up for MPGN
(Specify) Proteinuria (foamy urine), hematuria (blood in urine), hypertension, fatigue, swelling (edema)
History of Present Illness:
For new patients, describe the onset, duration, and severity of symptoms suggestive of MPGN.
For follow-up visits, inquire about any new or worsening symptoms since the last encounter.
Mention any recent changes in medications, illnesses, or exposures.
Past Medical History:
Underlying conditions potentially associated with MPGN (e.g., autoimmune diseases, chronic infections).
Previous treatments for MPGN or related conditions.
History of kidney disease or other relevant medical conditions.
Medications:
List all current medications, including any medications for MPGN treatment or supportive care.
Social History:
Inquire about tobacco use (may worsen kidney function).
Family history of kidney disease or autoimmune disorders.
Family History:
Presence of kidney disease or autoimmune disorders in first-degree relatives.
Physical Exam:
Vital signs: Assess for elevated blood pressure and signs of fluid overload (edema).
General observation: Look for signs of pale appearance or jaundice (yellowing of skin).
Laboratory Tests:
Urinalysis: May reveal proteinuria, hematuria, and red blood cell casts.
Urine protein-to-creatinine ratio (UACR): Quantifies proteinuria for diagnosis and monitoring.
Serum creatinine: Assesses kidney function.
Blood count (CBC): May reveal anemia if kidney function is significantly impaired.
Complement levels: Low levels of C3 are a hallmark finding in some forms of MPGN.
Other laboratory tests may be indicated based on specific concerns (e.g., autoimmune workup, antibodies associated with specific MPGN types).
Imaging Studies:
Kidney ultrasound: May reveal abnormalities in kidney size or echogenicity.
Kidney biopsy: The definitive diagnostic test for MPGN, providing information about the pattern of glomerular injury and potential underlying cause.
Assessment:
Membranoproliferative glomerulonephritis (MPGN): Based on clinical presentation, laboratory findings, and imaging studies (if available), suspect or confirm MPGN.
Specific type of MPGN (if possible): There are several subtypes of MPGN, each with potential underlying causes. Distinguish between types based on clinical features, laboratory tests (e.g., complement levels, autoantibodies), and biopsy findings (if performed).
Severity of kidney disease: Assess the severity of kidney dysfunction based on urinary protein excretion, serum creatinine, and glomerular filtration rate (GFR) calculated from creatinine.
Plan:
Treatment (depends on the type and severity of MPGN):
Immunosuppressive medications (e.g., corticosteroids, cyclophosphamide) may be used to suppress the immune system and reduce inflammation.
Plasma exchange may be used in some cases to remove harmful proteins from the blood.
Blood pressure control is crucial to prevent further kidney damage.
Medications to lower proteinuria may be used.
Management of underlying conditions contributing to MPGN (e.g., infections, autoimmune disorders).
Dietary management: May involve protein restriction and sodium restriction to reduce workload on the kidneys.
Monitoring: Schedule regular follow-up visits with laboratory tests (including kidney function tests and urinalysis) and imaging studies (as needed) to monitor disease activity and response to treatment.
Referral to a nephrologist: Consider referral to a nephrologist for specialized care, especially for complex cases or those requiring advanced treatment options.
Education:
Educate the patient about MPGN, symptoms, potential causes, treatment options, and the importance of adherence to medication and dietary recommendations.
Discuss the importance of regular follow-up and potential long-term complications of MPGN.
Provide resources for kidney disease support groups or patient advocacy organizations.
Disclaimer: This template is for informational purposes only and should be adapted to the specific needs of each patient. Membranoproliferative glomerulonephritis