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Glomerulonephritis

Glomerulonephritis is a topic covered in the 5-Minute Emergency Consult.

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Basics

Description

  • Syndrome characterized by:
    • Hematuria
    • Proteinuria
    • Red blood cell casts
    • Hypertension
    • Renal insufficiency
  • Common pathway of multiple diseases resulting in intraglomerular inflammation and cellular proliferation
  • Contributing factors:
    • Genetics
    • Infectious
    • Rheumatologic
    • Leading to antibody deposition:
      • Antibody attaches to glomerular antigen (native or implanted).
      • Circulating antigen–antibody complex deposited
    • Causing an influx and activation of inflammatory mediators:
      • Leukocytes, complement, cytokines
      • Cell-mediated immune mechanisms
  • Results in glomerular dysfunction
  • Persistent inflammation that can lead to scarring and permanent damage.

Etiology

  • Postinfectious:
    • Poststreptococcal glomerulonephritis (PSGN):
      • Occurs 7–21 days after Streptococcal pharyngitis or skin infection
      • Highest prevalence in ages 2–14 and the elderly
      • Male predominance
      • Ranges from asymptomatic hematuria to oliguric renal failure
    • Can follow other bacterial, fungal, viral, or parasitic infections
  • IgA nephropathy (Berger disease):
    • Most common in men in the 3rd and 4th decades of life
    • Possibly related to increased production of IgA after infection usually a URI
    • Henoch–Schönlein purpura (HSP) has IgA nephropathy but affects a younger age and has systemic symptoms
  • Rapidly progressive glomerulonephritis (RPGN):
    • Can destroy renal function in days
    • Crescentic deposits in glomeruli destroy function.
    • Pauci-immune (small vessel vasculitides):
      • Often antineutrophil cytoplasmic antibody (ANCA)-positive
      • Can involve other areas (i.e., lungs, skin)
      • Wegener granulomatosis
      • Microscopic polyangiitis
      • Churg–Strauss syndrome
    • Immune complex deposits:
      • Postinfectious
      • Endocarditis associated
      • Systemic disease (i.e., systemic lupus erythematosus [SLE], HSP)
    • Anti-glomerular basement membrane (GBM) deposits:
      • Older patients of age >60
      • Goodpasture disease with pulmonary involvement
  • Membranoproliferative glomerulonephritis (MPGN):
    • Complement deposits in basement membrane
    • Hepatitis C
    • Non-Hodgkin lymphoma
    • Occult infection

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Citation

Rosen, Peter, et al., editors. "Glomerulonephritis." 5-Minute Emergency Consult, 5th ed., Lippincott Williams & Wilkins, 2016. Emergency Central, emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307288/all/Glomerulonephritis.
Glomerulonephritis. In: Rosen P, Shayne P, Barkin AZ, et al, eds. 5-Minute Emergency Consult. 5th ed. Lippincott Williams & Wilkins; 2016. https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307288/all/Glomerulonephritis. Accessed April 20, 2019.
Glomerulonephritis. (2016). In Rosen, P., Shayne, P., Barkin, A. Z., Wolfe, R. E., Hayden, S. R., Barkin, R. M., & Schaider, J. J. (Eds.), 5-Minute Emergency Consult. Available from https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307288/all/Glomerulonephritis
Glomerulonephritis [Internet]. In: Rosen P, Shayne P, Barkin AZ, Wolfe RE, Hayden SR, Barkin RM, Schaider JJ, editors. 5-Minute Emergency Consult. Lippincott Williams & Wilkins; 2016. [cited 2019 April 20]. Available from: https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307288/all/Glomerulonephritis.
* Article titles in AMA citation format should be in sentence-case
TY - ELEC T1 - Glomerulonephritis ID - 307288 ED - Rosen,Peter, ED - Shayne,Philip, ED - Barkin,Adam Z, ED - Wolfe,Richard E, ED - Hayden,Stephen R, ED - Barkin,Roger M, ED - Schaider,Jeffrey J, BT - 5-Minute Emergency Consult UR - https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307288/all/Glomerulonephritis PB - Lippincott Williams & Wilkins ET - 5 DB - Emergency Central DP - Unbound Medicine ER -