Related Subjects:
|Metabolic acidosis
|Lactic acidosis
|Acute Kidney Injury (AKI) / Acute Renal Failure
|Renal/Kidney Physiology
|Chronic Kidney Disease (CKD)
|Anaemia in Chronic Kidney Disease
|Analgesic Nephropathy
|Medullary Sponge kidney
|IgA Nephropathy (Berger's disease)
|HIV associated nephropathy (HIVAN)
|Balkan endemic nephropathy (BEN)
|Autosomal Dominant Polycystic kidney disease
Rapid diagnosis of especially the Rapidly progressive form can allow early treatment and improve outcome. Measure ANCA and anti-GBM
About
- Inflammation of the glomerulus. Often Immune generated response
- Changes to the basement membrane, mesangium, or capillary endothelium
- Antibody mediate injury, complement, cell-mediated immunity
Classifications are many and not standard
- Clinical : Nephritic vs Nephrotic
- Treatment : Steroid responsive vs Non steroid responsive
- Aetiology : e.g. Post streptococcal
- Histology: focal (affects some glomeruli), diffuse (all glomeruli) segmental (only parts of glomerulus), basement membrane changes and sclerosis
Primary GN : Aetiological Classification
- Minimal change disease [See topic]
- Focal segmental glomerulosclerosis
- Membranous Nephropathy
- IgA nephropathy
- Rapidly progressive glomerulonephritis: Anti GBM disease and pauci immune glomerulonephritis
- Post Streptococcal infection
- Membranoproliferative
Secondary GN
Clinical
- Acute onset haematuria, proteinuria, and red blood cell casts
- Hypertension, oedema, and impaired renal function.
- Hypertension with headache/neurology is ominous
Investigations
- FBC - anaemia
- Urinalysis - red cell casts, proteinuria, haematuria
- U&E ? Urea ? Creatinine ? K+ Calcium ?
- ESR and CRP may be elevated
- Blood gas ? HCO3 (metabolic acidosis)
- Immunological tests
- Anti-nuclear antibodies (ANA)
- Extractable nuclear antigen (ENA)
- Anti-neutrophil cytoplasmic antibody (ANCA)
- Anti-glomerular basement membrane (GBM) antibodies,
- Cryoglobulins
- Complements
- Anti-streptolysin O titre (ASOT)
- Serum protein electrophoresis
- 24-h urinary protein loss
- Renal Ultrasound and Renal biopsy
Complement
- Complement may be useful in the determination of causes of Acute Glomerulonephritis
- Low serum complement levels: Cryoglobulinaemia, Systemic lupus erythematosus, Bacterial endocarditis, Shunt nephritis, Membranoproliferative or post-streptococcal glomerulonephritis
- Normal serum complement levels: Polyarteritis nodosa, Goodpasture syndrome, Henoch-Schönlein purpura, Immune complex disease, Idiopathic rapidly progressive glomerulonephritis, IgG or IgA nephropathy.
Management
- Admit if anuria, nephrotic syndrome, massive proteinuria, significant hypertension, or pulmonary symptoms
- Restrict fluids in patients with significant oedema and fluid overload.
- Loop diuretics are indicated for nephrotic syndrome (4% of patients) or massive proteinuria.
- Severe hypertension with headache/neurology needs urgent management with calcium channel blockers and Nitroprusside
Possible Indications for steroids
- Vasculitis : steroids
- SLE : Steroids
- Henoch Schönlein : Steroids
- Granulomatosis with polyangiitis : Steroids and then oral Cyclophosphamide,
- Idiopathic rapidly progressive Glomerulonephritis, pulse intravenous Methylprednisolone is used to reduce the risk of progression to end-stage renal disease
- Goodpasture syndrome, Plasmapheresis is combined with immunosuppression (ie, prednisone and cyclophosphamide). High-dose pulse steroids are effective for pulmonary haemorrhage.