Glomerulonephritis

Last reviewed: 3 Sep 2022
Last updated: 12 Aug 2022

Summary

Definition

History and exam

Key diagnostic factors

  • presence of risk factors
  • haematuria
  • oedema
  • hypertension
More key diagnostic factors

Other diagnostic factors

  • oliguria
  • anorexia
  • nausea
  • malaise
  • weight loss
  • fever
  • skin rash
  • arthralgia
  • haemoptysis
  • abdominal pain
  • sore throat
  • hypervolaemia
Other diagnostic factors

Risk factors

  • group A beta-haemolytic Streptococcus
  • respiratory infections
  • gastrointestinal infections
  • hepatitis B
  • hepatitis C
  • infective endocarditis
  • HIV
  • systemic lupus erythematosus (SLE)
  • systemic vasculitis
  • Hodgkin's lymphoma
  • lung cancer
  • colorectal cancer
  • non-Hodgkin's lymphoma
  • leukaemia
  • thymoma
  • haemolytic uraemic syndrome
  • drugs
More risk factors

Diagnostic investigations

1st investigations to order

  • urinalysis and urine microscopy
  • comprehensive metabolic profile
  • glomerular filtration rate (GFR)
  • full blood count
  • lipid profile
  • spot urine albumin:creatinine ratio (ACR)
  • ultrasound of kidneys
More 1st investigations to order

Investigations to consider

  • erythrocyte sedimentation rate (ESR) or C-reactive protein (CRP)
  • complement levels
  • rheumatoid factor
  • anti-neutrophil cytoplasmic antibody
  • anti-glomerular basement membrane (GBM) antibody
  • antistreptolysin O antibody
  • antihyaluronidase
  • anti-DNase
  • anti-double-stranded DNA
  • antinuclear antibody
  • cryoglobulins
  • hepatitis C virus and hepatitis B serology
  • HIV serology
  • electrophoresis
  • drug screen
  • renal biopsy
  • antiphospholipase A2 receptor antibodies
  • computed tomographic scan of chest and abdomen
More investigations to consider

Treatment algorithm

ACUTE

mild disease

moderate-severe disease

rapidly progressive

ONGOING

persistent haematuria, proteinuria, or reduced GFR

Contributors

Authors

Jeremy Levy, MA, PhD, DSc (Hon), FHEA, FRCP

Professor of Practice (Medicine)

Director of Clinical Academic Training

Imperial College London

Consultant Nephrologist

Imperial College Healthcare NHS Trust

London

UK

Disclosures

JL declares that he has no competing interests.

Acknowledgements

Dr Jeremy Levy would like to gratefully acknowledge Dr Padmanabhan Premkumar, Dr Priyanka Sharma, and Dr Ajay Kumar, previous contributors to this topic. PP, PS, and AK declare that they have no competing interests.

Peer reviewers

Martin Schreiber, MD

Department Chairman

Nephrology and Hypertension

Cleveland Clinic Foundation

Cleveland

OH

Disclosures

MS declares that he has no competing interests.

Patrick Naish, MB, FRCP

Teaching Fellow

Keele University Medical School

Keele

UK

Disclosures

PN declares that he has no competing interests.

Richard Banks, MBBS, FRCP, MD

Consultant Nephrologist

Gloucestershire Royal Hospital

Gloucester

UK

Disclosures

RB declares that he has no competing interests.

  • Glomerulonephritis images
  • Differentials

    • Nephrolithiasis
    • Bladder cancer
    • Renal cancer
    More Differentials
  • Guidelines

    • KDIGO clinical practice guideline for glomerular diseases
    • Evidence-based clinical practice guidelines for rapidly progressive glomerulonephritis 2014
    More Guidelines
  • Patient leaflets

    Glomerulonephritis

    Kidney infection

    More Patient leaflets
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