From the Guidelines
Acute glomerulonephritis is primarily caused by immune-mediated inflammation of the glomeruli, with post-streptococcal glomerulonephritis being a common cause, as well as other infectious and systemic diseases, including lupus nephritis, IgA nephropathy, and ANCA-associated vasculitis, as discussed in the 2021 KDIGO clinical practice guideline for the management of glomerular diseases 1.
Causes of Acute Glomerulonephritis
The causes of acute glomerulonephritis can be categorized into several groups, including:
- Infectious causes, such as post-streptococcal glomerulonephritis, bacterial endocarditis, viral infections (like hepatitis B and C, HIV), and parasitic infections
- Systemic diseases, including lupus nephritis, IgA nephropathy, Goodpasture syndrome, ANCA-associated vasculitis (such as granulomatosis with polyangiitis), and cryoglobulinemia
- Medication-induced causes, such as NSAIDs, penicillins, sulfonamides, and allopurinol
Pathophysiology
The underlying pathophysiology of acute glomerulonephritis involves immune complex deposition in the glomerular basement membrane or direct antibody attack against glomerular structures, triggering inflammation, complement activation, and neutrophil infiltration, as described in the KDIGO guideline 1.
Clinical Management
Early identification of the underlying cause is crucial for appropriate management of acute glomerulonephritis, and the KDIGO guideline provides evidence-based recommendations and practice points for the management of glomerular diseases, including acute glomerulonephritis 1.
Key Considerations
In clinical practice, it is essential to consider the potential causes of acute glomerulonephritis and to manage the condition accordingly, taking into account the latest evidence and guidelines, such as the 2021 KDIGO clinical practice guideline for the management of glomerular diseases 1.
From the Research
Causes of Acute Glomerulonephritis
The causes of acute glomerulonephritis (AGN) can be attributed to various factors, including:
- Infections, such as beta-hemolytic streptococcal infection, which is the most common cause in developing countries 2
- Primary renal glomerular disorders, like membranoproliferative glomerulonephritis (GN) and IgA nephropathy 2
- Collagen vascular diseases, including systemic lupus erythematosus 2
- Systemic vasculitis, such as Henoch-Schonlein purpura 2
- Hereditary nephritis and non-glomerular conditions 2
- Post-infectious glomerulonephritis, which can be caused by various infections, including group A β-hemolytic streptococcus (GAS) or Streptococcus pyogenes infections 3, 4
Immune Complex-Mediated Glomerulonephritis
Acute post-streptococcal glomerulonephritis (APSGN) is an example of an immune-complex mediated glomerular disease, triggered by GAS or Streptococcus pyogenes infections 3. The deposition of immune complexes in the glomeruli leads to inflammation and injury, resulting in the clinical manifestations of APSGN 3, 4.
Other Causes
Other causes of glomerulonephritis include:
- Anti-neutrophil cytoplasmic antibodies-associated vasculitis 5
- Anti-glomerular basement membrane disease 5
- C3 glomerulopathy 5
- Monoclonal immunoglobulin-associated glomerulonephritis 5
- IgA vasculitis 6
Pathogenesis
The pathogenesis of glomerulonephritis involves an interplay of immune-mediated mechanisms, host characteristics, and environmental triggers, such as infections 6. The activation of the complement system and the deposition of immune complexes in the glomeruli play a critical role in the development of glomerulonephritis 3, 4.