Glomerulonephritis
Basics
Description
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
Etiology
- Postinfectious:
- Poststreptococcal glomerulonephritis (PSGN):
- Usually occurs 7–21 d after Streptococcal pharyngitis or skin infection, but can occur as late as 6 wk after skin infection
- Caused when exotoxins released by group A streptococci bind to glomeruli, activating an antibody response
- 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
- Poststreptococcal glomerulonephritis (PSGN):
- IgA nephropathy (Berger disease):
- Most common in men in the third and fourth decades of life
- Possibly related to increased production of IgA after infection, usually a URI in genetically susceptible individuals
- 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):
- Necrotizing glomerulonephritis with no immune deposits
- 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:
- Unclear trigger, but may be postinfectious
- 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
Schaider, Jeffrey J., et al., editors. "Glomerulonephritis." 5-Minute Emergency Consult, 6th ed., Lippincott Williams & Wilkins, 2020. Emergency Central, emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307288/all/Glomerulonephritis.
Glomerulonephritis. In: Schaider JJJ, Barkin RMR, Hayden SRS, et al, eds. 5-Minute Emergency Consult. Lippincott Williams & Wilkins; 2020. https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307288/all/Glomerulonephritis. Accessed December 1, 2024.
Glomerulonephritis. (2020). In Schaider, J. J., Barkin, R. M., Hayden, S. R., Wolfe, R. E., Barkin, A. Z., Shayne, P., & Rosen, P. (Eds.), 5-Minute Emergency Consult (6th ed.). Lippincott Williams & Wilkins. https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307288/all/Glomerulonephritis
Glomerulonephritis [Internet]. In: Schaider JJJ, Barkin RMR, Hayden SRS, Wolfe RER, Barkin AZA, Shayne PP, Rosen PP, editors. 5-Minute Emergency Consult. Lippincott Williams & Wilkins; 2020. [cited 2024 December 01]. Available from: https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307288/all/Glomerulonephritis.
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