Glomerulonephritis is often part of a multisystem disorder.
Edema is a sign of severe or chronic disease.
A renal biopsy is the test for definitive diagnosis, although it is not required in all patients.
Treating the underlying disorder and managing hypertension, hyperlipidemia, and proteinuria is the mainstay of therapy.
Some patients may eventually need dialysis or transplant.
Regular, and sometimes frequent, monitoring of renal function is critical.
Glomerulonephritis (GN) denotes glomerular injury and applies to a group of diseases that are generally, but not always, characterized by inflammatory changes in the glomerular capillaries and the glomerular basement membrane (GBM). The injury can involve a part or all of the glomeruli or the glomerular tuft. The inflammatory changes are mostly immune mediated. Diseases include membranous GN, minimal change disease, focal and segmental glomerulosclerosis, immunoglobulin A nephropathy, forms of rapidly progressive GN (vasculitis and anti-GBM disease), and lupus nephritis as the more common forms.
History and exam
Key diagnostic factors
Other diagnostic factors
- weight loss
- skin rash
- abdominal pain
- sore throat
- group A beta-hemolytic Streptococcus
- respiratory infections
- gastrointestinal infections
- hepatitis B
- hepatitis C
- infective endocarditis
- systemic lupus erythematosus (SLE)
- systemic vasculitis
- Hodgkin lymphoma
- lung cancer
- colorectal cancer
- non-Hodgkin lymphoma
- hemolytic uremic syndrome
1st investigations to order
- urinalysis and urine microscopy
- comprehensive metabolic profile
- glomerular filtration rate (GFR)
- complete blood count
- lipid profile
- spot urine albumin:creatinine ratio (ACR)
- ultrasound of kidneys
Investigations to consider
- erythrocyte sedimentation rate (ESR) or C-reactive protein (CRP)
- complement levels
- rheumatoid factor
- antineutrophil cytoplasmic antibody
- antiglomerular basement membrane (GBM) antibody
- antistreptolysin O antibody
- anti-double-stranded DNA
- antinuclear antibody
- hepatitis C virus and hepatitis B virus serology
- HIV serology
- drug screen
- renal biopsy
- antiphospholipase A2 receptor antibodies
- computed tomographic scan of chest and abdomen
persistent hematuria, proteinuria, or reduced GFR
Jeremy Levy, MA, PhD, DSc (Hon), FHEA, FRCP
Professor of Practice (Medicine)
Director of Clinical Academic Training
Imperial College London
Imperial College Healthcare NHS Trust
JL declares that he has no competing interests.
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.
Martin Schreiber, MD
Nephrology and Hypertension
Cleveland Clinic Foundation
MS declares that he has no competing interests.
Patrick Naish, MB, FRCP
Keele University Medical School
PN declares that he has no competing interests.
Richard Banks, MBBS, FRCP, MD
Gloucestershire Royal Hospital
RB declares that he has no competing interests.
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