Acute Glomerulonephritis

Acute glomerulonephritis is a disease characterised by damage to the glomerular filtration apparatus, which causes protein and blood to leak into the urine.
Mechanisms for the glomerular damage may be immune-mediated. This condition may be associated with hypertension and fluid retention.

Causes of Acute Glomerulonephritis

The following are some of the known causes of acute glomerulonephritis

  1. Post streptococcal infections (pharyngeal or skin infections)
  2. Infected scabies
  3. Other bacterial infections e.g. salmonella
  4. Hepatitis B virus, Hepatitis C virus,
  5. HIV
  6. Parasitic e.g. Schistosoma, Malaria
  7. Systemic lupus erythematosus and other vasculitides

Symptoms of Acute Glomerulonephritis

Some known and common symptoms of acute glomerulonephritis including the following:

  1. A history of preceding infection
  2. Generalized oedema most marked around the eyes
  3. Breathlessness
  4. Anorexia (sometimes associated with vomiting and abdominal pain)
  5. Fever Seizures
  6. Scanty urine
  7. Haematuria

Signs of Acute Glomerulonephritis

The following are signs of acute glomerulonephritis:

  1. Oedema
  2. Oliguria (urine volumes < 400 ml/day)
  3. Hypertension
  4. Haematuria
  5. Dark coloured urine
  6. Acute heart failure
  7. Coma

Investigations

  • Urinalysis
  • Sediment shows erythrocytes, leukocytes and a variety of casts including erythrocyte casts
  • Proteinuria usually less than 2 g/24 hours but may be in the nephrotic range
  • FBC
  • BUE and Creatinine
  • Throat cultures (in children may be useful)
  • Chest X-ray (may show pulmonary oedema) ECG
  • Immunology (e.g. ANA, AntiDsDNA)
  • ASO (antistreptolysin O) titres
  • Ultrasound of kidneys

Treatment for acute glomerulonephritis

Treatment objectives

The treatment objectives of acute glomerulonephritis include the following:

  1. To identify and stop the cause of renal injury
  2. To prevent and control complications
  3. To improve the patients quality of life

Non-pharmacological treatment

The following measures help patients with acutete glomerulonephritis

  1. Bed rest
  2. Salt restriction in diet
  3. Control fluid balance:
    • Adults: Control fluid retention by restricting daily fluid intake to 800 ml plus previous day’s urine output.
    • Children: Restrict fluids to 400 ml/m2 of body surface area and previous day’s urine output.

Pharmacological treatment

A. For fluid retention in Post-infectious glomerulonephritis

 
Evidence Rating: [B]
Furosemide, oral or IV,
Adult: 40 mg daily, increasing to 80 mg daily
Children:

  • 1 month-12 years; 1-2 mg/kg/day initially. Increase by 1-2 mg/kg 8 hourly to a max. of 6 mg/kg per day, not to exceed 80 mg per day.
  • Neonates: 0.5-1 mg/kg 8 to 24 hourly; max. 2 mg/kg.

B. For hypertension in Post-infectious Glomerulonephritis

 
Treat blood pressure ( ‘Hypertension‘)

Referral Criteria

Refer all patients with complications of renal failure, severe cardiac failure and hypertensive encephalopathy that arise following post infectious glomerulonephritis to a physician specialist or a nephrologist.
Patients with other causes such as lupus nephritis or systemic vasculitis, should also be referred to a physician specialist or a nephrologist.