Glomerulonephritis

Glomerulonephritis is inflammation of the tiny filters in the kidneys (glomeruli).The excess fluid and waste that glomeruli remove from the bloodstream exit the body as urine. Glomerulonephritis can come on suddenly (acute) or gradually (chronic).

Essentials of diagnosis

• Hematuria, mild proteinuria (usually sub - nephrotic range)
• Non - dysmorphic or dysmorphic red cells
• Red cell casts pathognomonic but not required for diagnosis
• Dependent edema and hypertension

Investigations

• RFTS (Serum creatinine can rise over days to months, depending on the rapidity of the underlying process)
• Urine Anaylysis; Dipstick and microscopic evaluation will reveal evidence of hematuria and typically mild proteinuria (less than 3 g / day). There may be cellular elements such as dysmorphic red cells, red cell casts, and white cells. Red cell casts are specific for glomerulonephritis
• Urinary protein creatinine ratios or 24 - hour urinary proteins (to quantify protein excretion)
• Other tests include serum complement levels, ASO titers, anti GBM antibody levels, ANCAS, antinuclear antibody titers, cryoglobulins, hepatitis serologies, serum protein electrophoresis and serum free light chains, blood cultures and renal ultrasound.
• kidney biopsy to confirm the diagnosis

Management

• Depending on the nature and severity of disease, treatment might include high - dose corticosteroids, calcineurin inhibitors (cyclosporine, tacrolimus etc.) rituximab, and cytotoxic agents such as cyclophosphamide.
• Plasma exchange can be used in Goodpasture syndrome and pauci- immune glomerulonephritis temporarily until medications can take effect.