From the Guidelines
Glomerulonephritis is a condition characterized by inflammation of the glomeruli, the tiny filtering units in the kidneys, and can lead to kidney damage, kidney failure, high blood pressure, and fluid retention, with examples including post-streptococcal glomerulonephritis, lupus nephritis, IgA nephropathy, membranous nephropathy, and rapidly progressive glomerulonephritis, as outlined in the KDIGO 2021 guideline for the management of glomerular diseases 1.
Definition and Examples
Glomerulonephritis can be acute or chronic, and its treatment depends on the specific type and cause. The condition is often associated with immune-mediated injury to the glomeruli, either through antibody deposition, immune complex formation, or direct cellular damage, which disrupts the normal filtering function of the kidneys.
- Post-streptococcal glomerulonephritis occurs after a streptococcal infection
- Lupus nephritis is associated with systemic lupus erythematosus
- IgA nephropathy involves immunoglobulin A deposits in the glomeruli
- Membranous nephropathy is characterized by thickening of the glomerular basement membrane
- Rapidly progressive glomerulonephritis can quickly lead to kidney failure, as discussed in the KDIGO 2021 clinical practice guideline for the management of glomerular diseases 1
Treatment Approaches
Treatment of glomerulonephritis may include:
- Corticosteroids like prednisone (starting at 1 mg/kg/day)
- Immunosuppressants such as cyclophosphamide or mycophenolate mofetil
- Blood pressure medications like ACE inhibitors
- Diuretics to reduce fluid retention The KDIGO 2021 guideline provides evidence-based recommendations for the management of glomerular diseases, including glomerulonephritis, and emphasizes the importance of a systematic approach to diagnosis, prognosis, treatment, and special situations 1.
From the Research
Definition of Glomerulonephritis
Glomerulonephritis refers to a group of diseases characterized by inflammatory glomerular processes, which can present with a nephritic and/or a nephrotic syndrome, as well as a deterioration of renal function 2. It is a heterogeneous group of disorders that cause glomerular inflammation and injury through an interplay of immune-mediated mechanisms, host characteristics, and environmental triggers, such as infections 3.
Examples of Glomerulonephritis
Examples of glomerulonephritis include:
- Lupus nephritis
- IgA nephropathy
- IgA vasculitis
- Postinfectious glomerulonephritis
- Anti-neutrophil cytoplasmic antibodies-associated vasculitis
- Anti-glomerular basement membrane disease
- C3 glomerulopathy
- Monoclonal immunoglobulin-associated glomerulonephritis 3, 4
Classification of Glomerulonephritis
Glomerulonephritis can be broadly classified into several categories, including:
- Immune-complex glomerulonephritis (including infection-related glomerulonephritis, IgA nephropathy, lupus nephritis, and cryoglobulinaemic glomerulonephritis)
- Anti-neutrophil cytoplasmic antibodies-associated (pauci-immune) glomerulonephritis
- Anti-glomerular basement membrane glomerulonephritis
- C3 glomerulopathy
- Monoclonal immunoglobulin-associated glomerulonephritis 4 Alternatively, glomerulonephritis can be categorized into five categories according to their immunopathogenesis: infection-related GN, autoimmune GN, alloimmune GN, autoinflammatory GN, and monoclonal gammopathy-related GN 5
Clinical Presentation and Diagnosis
Glomerulonephritis can manifest solely in the kidney or in the setting of a systemic illness, and presentation can range from chronic and relatively asymptomatic hematuria to fulminant renal failure 3. The gold standard for the diagnosis of a glomerulonephritis is a kidney biopsy, with a hallmark glomerular inflammation that translates into various histopathological patterns depending on the location and severity of the glomerular injury 4. Urinalysis shows abnormalities in the very early phases of glomerulonephritis and should be performed in all patients, as soon as any evidence of renal involvement is present 2.