Glomerulonephritis

 

[Also see Haematuria topic]

 

Glomerulonephritis is characterised by proteinuria, haematuria, hypertension & sometimes reduced renal function

Leaky glomerulus results in haematuria or proteinuria.

Inflammation and accumulation of cells reduce glomerular filtration causing reduced renal function, water tension and hypertension.

Common causes

– Post streptococcal glomerulonephritis 
– IgA nephropathy
– Alport syndrome (Basement memb dis)
– Henoch Schönlein Purpura
– Systemic Lupus Erythematosis

 

History

– Recent infections of skin, throat or GIT
– Reduced urine output and puffiness on face or ankles
– Dark (cola coloured) urine with reduced urine output
– Headaches, visual changes or breathlessness
– Abdominal pain or renal colic
– Rash and joint pains (in HSP)
– Chronic causes can present with intermittent episodes of Haematuria
– Associated family h/o hearing loss in Alport syndrome

Examination

• Examine skin, ENT
• Look for dependent oedema or puffiness over face
• Record blood pressure
• Monitor weight
• Bedside urine dipstick & microscopy

Investigations

– Urine dipstick to look for haematuria & proteinuria

– Urine microscopy for red cell shape and casts

– Urine culture to exclude UTI

– Baseline U&E

– Throat swab and ASO/ anti-DNAase titre, C3 & C4

– Consider renal tract USS

– Refer to Nephrology for renal biopsy if atypical features, persistent haematuria / proteinuria

Management principles

– Supportive care with monitoring of urine output, weight, haematuria and proteinuria

– If impaired renal function, may need dialysis

– Hypertension may need controlling with ACE-inhibitors or Ca-channel blockers

– Further management depends on cause, may need advice from Nephrologist

Post streptococcal glomerulonephritis

Commonest cause, caused by group A streptococcal infection, typically in 5-12 year age group

Present generally 2 to 3 weeks after a sorethroat or 4 to 6 weeks after skin infection

There is rise in ASOT and anti-DNAase B titre
C3 is typically low (normalises in 8weeks) but C4 is normal
Give Penicillin V for 10 days
Monitor haematuria, BP and weight for 8weeks

IgA nephropathy (Berger disease)

Seen in adolescence are young adults as commonest cause of chronic glomerulonephritis

Recurrent haematuria preceded by URTI
Normal C3 & C4
Renal biopsy shows IgA glomerular deposits

Poor prognosis if heavy proteinuria or reduced renal function

Alport syndrome

Genetic X- linked, affects type 4 collagen causing abnormal basement membrane
Asymptomatic microscopic haematuria
Associated with bilateral sensory neural hearing loss

Can cause progressive proteinuria leading to end stage renal disease