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
- Post streptococcal infections (pharyngeal or skin infections)
- Infected scabies
- Other bacterial infections e.g. salmonella
- Hepatitis B virus, Hepatitis C virus,
- HIV
- Parasitic e.g. Schistosoma, Malaria
- Systemic lupus erythematosus and other vasculitides
Symptoms of Acute Glomerulonephritis
Some known and common symptoms of acute glomerulonephritis including the following:
- A history of preceding infection
- Generalized oedema most marked around the eyes
- Breathlessness
- Anorexia (sometimes associated with vomiting and abdominal pain)
- Fever Seizures
- Scanty urine
- Haematuria
Signs of Acute Glomerulonephritis
The following are signs of acute glomerulonephritis:
- Oedema
- Oliguria (urine volumes < 400 ml/day)
- Hypertension
- Haematuria
- Dark coloured urine
- Acute heart failure
- 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:
- To identify and stop the cause of renal injury
- To prevent and control complications
- To improve the patients quality of life
Non-pharmacological treatment
The following measures help patients with acutete glomerulonephritis
- Bed rest
- Salt restriction in diet
- 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.