Glomerulonephritis
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Contents |
More Specific Terms
- anti-glomerular basement membrane [GBM] disease
- chronic glomerulonephritis
- crescentic glomerulonephritis (rapidly progressive glomerulonephritis)
- drug-induced glomerulonephritis (GN)
- fibrillary glomerulonephritis
- focal segmental glomerulosclerosis
- Goodpasture's syndrome
- IgA nephropathy; focal glomerulonephritis; mesangial proliferative glomerulonephritis; Berger's disease
- immunotactoid glomerulonephritis
- lupus nephritis
- membranoproliferative glomerulonephritis
- membranous glomerulonephritis; mesangiocapillary glomerulonephritis (membranous nephropathy)
- postinfectious glomerulonephritis
Introduction
Etiology
- (also seen expanded etiology of GN)
- idiopathic glomerulonephritis ( GN)
- secondary glomerulonephritis ( GN)
-
- connective tissue disease
- Henoch Schonlein purpura*
- cryoglobulinemia
- multiple myeloma
- Alport's syndrome
- hemolytic uremic syndrome
- pharmaceutical agents
- * most common etiologies
Pathology
- general
- infiltration of inflammatory cells
- proliferation of glomerular cells
- immunofluorescent staining
- granular pattern:
- post- streptococcal GN
- lupus nephritis
- endocarditis
- linear pattern: Goodpasture's syndrome
- negative immunofluorescence:
- idiopathic crescentic GN can have granular, linear or negative immunofluorescent pattern
Genetics
- ( biochemistry)
- upregulation of SCLY
Clinical-manifestations
- general
- dyspnea: pulmonary edema
- edema: lower extremities, periorbital
- oliguria & dark urine
- hypertension
- secondary signs/symptoms
- pharyngitis or dermatitis 2-3 weeks prior to onset of GN
- post- streptococcal GN
Laboratory
-
- hematuria
- RBC casts, dysmorphic erythrocytes
- proteinuria
- urine is 'cola' colored or smokey in appearance because of methemoglobin in acid urine
- serum chemistries
- creatinine clearance generally diminished
- urine protein (generally not nephrotic range)
- blood cultures: rule out endocarditis
- serologies
- antistreptolysin O ( ASO) titer, anti- DNAse antibodies
- anti-nuclear antibody ( ANA), anti-dsDNA
- serum complement: serum C3, serum C4, CH50
- low levels with:
- post- streptococcal GN
- endocarditis
- lupus nephritis
- membranoproliferative GN
- cryoglobulinemia (hepatitis C)
- normal levels with:
Diagnostic-procedures
-
- valvular lesions of endocarditis
- pericardial effusion
- kidney biopsy: immunofluorescent staining (when diagnosis is unclear)
- open lung biopsy or biopsy of nasal mucosa:
Radiology
- renal ultrasound is normal in glomerulonephritis
- chest X-ray
Differential-diagnosis
Management
- general considerations
-
- avoid ACE inhibitors & ARBs
- dialysis for severe renal failure
- diet
- sodium restriction < 2 g/day
- potassium restriction < 2 g/day
- follow-up
- long-term follow-up for chronic etiologies
- parameters of disease activity
- specific signs/symptoms of different etiologies
- specific therapies for different etiologies
- postinfectious glomerulonephritis: appropriate antibiotics
- immune-mediated glomerulonephritis
More General Terms
Additional Terms
- acute leukocytoclastic vasculitis (Henoch-Schonlein purpura)
- Alport syndrome
- classic polyarteritis nodosa (PAN)
- cryoglobulinemia (cryoglobulinemic vasculitis)
- etiology of glomerulonephritis
- Goodpasture's syndrome
- hemolytic uremic syndrome (HUS)
- microscopic polyangiitis
- multiple myeloma; plasmacytoma/plasma cell myeloma
- systemic lupus erythematosus
- Wegener's granulomatosis
References
- Saunders Manual of Medical Practice, Rakel (ed), WB Saunders, Philadelphia, 1996, pg 541-42
- Mayo Internal Medicine Board Review, 1998-99, Prakash UBS (ed) Lippincott-Raven, Philadelphia, 1998, pg 604-608
- Medical Knowledge Self Assessment Program (MKSAP) 11, 14, American College of Physicians, Philadelphia 1998, 2006
- Harrison's Principles of Internal Medicine, 13th ed. Isselbacher et al (eds), McGraw-Hill Inc. NY, 1994, pg 1295
- National Guideline Clearinghouse Glomerulonephritis. Singapore Ministry of Health ngc-guideline: [1]
