Glomerulonephritis: is it worth worrying about?

Abstract

-Glomerulonephritis (GN) is a group of conditions characterised by inflammation in the filtering units of the kidney which may be 'primary'; secondary to drugs, infections or tumours; or the presenting feature of systemic disease. GN is treatable, causes significant morbidity and mortality, and is a potentially preventable cause of renal failure and cardiovascular risk. It can only be precisely identified and characterised by renal biopsy which is usually undertaken in specialist nephrology centres. The role of the non-specialist is to know when and how urgently a patient should be referred to such a centre. This review aims to provide guidance on when to suspect GN, how to investigate this possibility and when to refer for further investigation. Clinically urgent situations are highlighted. The importance of urinary abnormalities, particularly proteinuria (even if aysmptomatic and only detected on routine screening) is emphasised. Earlier recognition of GN will improve patient outcomes.KEY WORDS: cardiovascular risk, glomerulonephritis, haematuria, nephrotic syndrome, proteinuria, renal failureThe term glomerulonephritis (GN) describes a group of conditions in which there is injury to the glomeruli, the filtering units of the kidney. My choice of title for this review was based on two aspects of my own personal experience. First, I remember when I was a medical student revising for my pathology examinations, I was daunted by the complex terminology associated with GN and decided that the subject was too esoteric to be a likely examination question. Therefore I felt it was 'not worth worrying about' and I omitted that section of my notes from my revision plans. Unfortunately for me, the final examination included an essay question on GN! Second, a friend of mine who is a general practitioner told me recently that she and her primary care colleagues are very concerned about GN as they realise that this is sometimes an urgent and important diagnosis to make. They routinely test urine samples in their surgeries and need guidance on when to suspect GN and how to react to the possibility that a patient has this condition. My aim here is to demystify GN, provide guidelines about when to suspect it, and give some general principles governing how to react to this diagnostic possibility. My answer to the question posed in the title is inevitably that YES, GN is worth worrying about, and I aim to provide guidance on when and how to turn the worrying to the patient's advantage. TerminologyThe obtuse terminology describing the various histological subtypes of GN is at least partly responsible for the perception that this is a complicated group of conditions, only understood by nephrologists in their ivory towers. However, the non-nephrologist should not be concerned about the detailed classification of GN. The different subtypes can only be identified accurately by renal biopsy: since this is only undertaken in specialist centres, the role of the generalist is to identify when and how urgently a given patient shoul...

Urine Annexin A1 as an Index for Glomerular Injury in Patients

“…Several studies have demonstrated that glomerular disorders are a multifactorial process caused by immune and nonimmune mechanisms that lead to glomerulosclerosis, tubulointerstitial fibrosis, inflammatory infiltration, loss of renal parenchyma, and renal vascular changes [ 5 , 6 ]. Although glomerular disorders can cause significant morbidity and mortality, they are treatable and constitute a preventable cause of renal failure and cardiovascular risk [ 7 ]. Importantly, the early recognition of the disease and the timely institution of appropriate treatment for patients with glomerular disorders should be beneficial.…”

Renal elastography measurements in children with acute glomerulonephritis

“…GN is a preventable risk factor for renal failure and cardiovascular disease [ 2 ]. The isolated presence of blood and/or protein in the urine, nephrotic (consisting of proteinuria, edema, and hyperlipidemia) or nephritic (consisting of hematuria and hypertension) syndromes, and acute or chronic kidney failure are clinical manifestations of glomerular involvement [ 3 ].…”

Primary glomerular disease

“…GN is an important cause of end-stage renal disease (ESRD) and late diagnosis of GN remains a major problem; non-specialists can have a vital role in improving the management of GN by knowing when to suspect it, arranging appropriate investigations and making early referral to a nephrologist. 1 Proteinuria is a cardinal feature of GN and the importance of proteinuria to the generalist is emphasized by the fact that it is now also recognized as an unequivocal independent cardiovascular risk factor. 2 Proteinuria may be asymptomatic, especially at low concentration; when severe it may be associated with nephrotic syndrome, in which the patient's symptoms typically include oedema and lethargy which can be profound.…”