Glomerulonephritis, often referred to as GN, is a group of kidney diseases that involve inflammation of the glomeruli—the tiny filtering units in the kidneys responsible for removing waste and excess fluid from the blood. Can be due to autoimmune processes
| Name | Cause | Most common presentation |
|---|---|---|
| Minimal change disease | ? autoimmune | children with nephrotic, little to no decrease in renal function. Give corticosteroids. |
| IgA nephropathy | autoimmune | Teens/young adults with nephritic. |
| Membranous nephropathy | autoimmune | Adults with nephrotic may have PMH of Hepatitis B or cancer |
| Focal segmental glomerulosclerosis | ? autoimmune | Adults with nephrotic may have PMH of HIV or anabolic steroid use |
| Lupus nephritis | autoimmune (Type III) | Other signs of Lupus. Variable renal presentation |
| Post infectious glomerulonephritis | autoimmune (Type III) | Children with Impetigo or strep throat |
| Granulomatosis with polyangiitis (Wegners) | autoimmune (Type III) | Haematuria and rapid fall in eGFR. Also nose and lung symptoms. |
| Goodpastures disease (anti GBM) | autoimmune (Type II) | Haematuria and a rapid fall in eGFR. Also haemoptysis due to lung involvement |
Causes/Factors
- Immune System Abnormalities: Immune responses targeting the glomeruli.
- Infections: Certain infections (like streptococcal infection) can trigger immune responses leading to GN.
- Autoimmune Diseases: Conditions like lupus or Goodpasture’s syndrome.
- Vasculitis: Inflammation of blood vessels affecting the glomeruli - microscopic polyangiitis and Granulomatosis with polyangiitis
- Hereditary Factors: Some forms of GN have a genetic component.
Symptoms
Nephrotic syndrome
- oedema
- hypoalbuminemia
- proteinuria >3.5g/day
Nephritic syndrome
- Acute Kidney Injury
- haematuria present
- proteinuria (non-nephrotic)
- hypertension
- Post-streptococcal
- Vasculitis
Signs
- Fluid Retention: Swelling in various body parts due to edema.
- High Blood Pressure: Essential hypertension.
- Urinalysis Findings: Hematuria, proteinuria, frothy urine
Diagnostic Tests
- Urinalysis
- Blood Tests: assess kidney function and look for signs of inflammation, immunological investigations.
- Renal Biopsy - for histology
Management
- Immune System Modulation: Corticosteroids and immunosuppressive medications.
- Blood Pressure Control: Medications to manage Essential hypertension and protect the kidneys.
- Diuretics: To manage edema.
- Dietary Modifications: Managing sodium and protein intake.
- Dialysis: In severe cases of Kidney Failure.
Complications/red Flags
- Chronic Kidney Disease: Progressive damage can lead to reduced kidney function.
- Nephrotic syndrome: Severe proteinuria, edema, and low protein levels.
- Acute Kidney Injury: Sudden decline in kidney function.