Acute Glomerulonephritis

Aka: Acute Glomerulonephritis, Glomerulonephritis

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II. Definition

  1. Gross Hematuria with Red Blood Cell Casts
  2. Proteinuria
  3. Hypertension
  4. Renal Insufficiency

III. Causes

  1. See Glomerulonephritis Causes
  2. Nephrotic Syndrome
    1. Minimal Change Disease (NIL Lesion, Lipoid nephrosis)
    2. Focal Segmental Glomerulosclerosis
    3. Membranous Glomerulonephritis
    4. Paraproteinemia (Multiple Myeloma)
  3. Nephritis with low complement
    1. Postinfectious proliferative Glomerulonephritis
      1. Poststreptococcal Glomerulonephritis (classic)
      2. Subacute Bacterial Endocarditis
      3. Osteomyelitis
    2. Membranoproliferative Glomerulonephritis
    3. Systemic Lupus Erythematosus
    4. Cryoglobulinemia
    5. Diabetes Mellitus
    6. Hepatitis CVirus
  4. Nephritis with normal complement
    1. IgA Nephropathy (Berger's Disease)
    2. Fibrillary Glomerulonephritis
    3. Goodpasture's Syndrome
    4. Rapidly Progressive Glomerulonephritis
    5. Renal Vasculitis
    6. Wegner's Granulomatosis
    7. Polyarteritis Nodosa

IV. Symptoms (variably present)

  1. Malaise
  2. Headache
  3. Anorexia
  4. Low grade fever

V. Symptoms and Signs

  1. Edema
  2. Hypertension

VI. Labs: Initial (characterize condition)

  1. Urine sediment examination
    1. Proteinuria
    2. Glomerular Hematuria
      1. Pigmented or Red Blood Cell Casts
      2. Dysmorphic Red Blood Cells
  2. Twenty-four hour urine collection
    1. 24 Hour Urine Protein
    2. Creatine Clearance
      1. Renal Insufficiency
  3. Routine blood testing
    1. Serum chemistries (e.g. Chem8)
    2. Albumin and Liver Function Tests
    3. Total Cholesterol
  4. If over age 40 with Proteinuria >1 gram/24 hours
    1. Serum Protein Electrophoresis (SPEP)
    2. Urine Protein electrophoresis

VII. Labs: Next (Screen for etiology)

  1. Serum Complement (C3, C4, CH50)
  2. Antinuclear Antibody (ANA)
  3. Rheumatoid Factor (RF)
  4. Erythrocyte Sedimentation Rate (ESR)
  5. Anti-Glomerular Basement Membrane Antibody titer
  6. Hepatitis Serology (HBsAg, xHBc IgM, HCV)
  7. Anti-Neutrophilic cytoplasmic Antibody (ANCA)
  8. Anti-streptolysin O titer (ASO Titer)
  9. Human Immunodeficiency Virus (HIV)

VIII. Diagnostics

  1. Renal Ultrasound
  2. Renal biopsy

IX. Management

  1. Treat specific cause

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