Disease Information for Glomerulonephritis/Glomerulitis

Edema; Hypertension; Hematuria (with or without dysmorphic red cells, red blood cell casts); Acute glomerulonephritis usually signifies an inflammatory process causing renal dysfunction over days to weeks that may or may not resolve; If the inflammatory process is severe, the glomerulonephritis may lead to a greater than 50% loss of nephron function over the course of just weeks to months; Such a process, called rapidly progressive acute glomerulonephritis, can cause permanent damage to glomeruli if not identified and treated rapidly; Prolonged inflammatory changes can result in chronic glomerulonephritis with persistent renal abnormalities that progress to ESRD; Edema is first seen in regions of low tissue pressure such as the periorbital and scrotal areas; Hypertension, if present, is due to volume overload rather than vasoactive substances such as angiotensin II, whose levels are low; Serum chemistries: There are no serum chemistries characteristic of nephritic syndrome, but certain special tests are often performed depending on the history and the results of the preliminary evaluation; These include complement levels, antinuclear antibodies (ANA), cryoglobulins, hepatitis serologies, ANCA, anti-GBM antibodies, antistreptolysin O (ASO) titers, and C3 nephritic factor; Serologic analysis of patients with glomerulonephritis; ANCA, anti-neutrophil cytoplasmic antibodies; GBM, glomerular basement membrane; GN, glomerulonephritis; MPGN, membranoproliferative glomerulonephritis; The urinalysis shows red blood cells; These may be misshapen from traversing a damaged capillary membrane-so-called dysmorphic red blood cells; Red blood cell casts and moderate degrees of proteinuria are also characteristic of the urinary sediment; Placing the patient in a lordotic position for an hour increases sensitivity for finding red cell casts in the next urine specimen; Renal biopsy should be considered if there are no other contraindications to biopsy (eg, Amyloid, bleeding disorders, thrombocytopenia, uncontrolled hypertension); Rapidly progressive glomerulonephritis is likely when over 50% of glomeruli contain crescents; The type of disease can be categorized according to the immunofluorescent pattern and appearance on electron microscopy; Treatment includes aggressive reduction of hypertension and fluid overload and specific therapeutic maneuvers aimed at the underlying cause; Salt and water restriction, diuretic therapy, and possibly dialysis are needed; The inflammatory glomerular injury may require corticosteroids and cytotoxic agents; [CMDXRX 2005];

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