Glomerulonephritis for NP
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Glomerulonephritis for the Nurse Practitioner Licensing Exam
- Definition:
- Glomerulonephritis (GN) refers to inflammation of the glomeruli, leading to impaired filtration in the kidneys. It presents with hematuria, proteinuria, edema, and hypertension, and can cause acute or chronic kidney injury.
- Etiology:
- Primary Glomerulonephritis:
- IgA Nephropathy (Berger’s Disease): The most common form of primary GN, often occurring after upper respiratory infections, presenting with gross hematuria and mesangial IgA deposits on biopsy.
- Membranoproliferative Glomerulonephritis (MPGN): Characterized by thickened glomerular capillary walls and immune complex deposition, often linked to chronic infections (e.g., hepatitis C).
- Secondary Glomerulonephritis:
- Post-Streptococcal Glomerulonephritis (PSGN): Occurs after a group A Streptococcal infection. Symptoms include cola-colored urine, edema, and hypertension.
- Lupus Nephritis: Seen in patients with systemic lupus erythematosus (SLE), causing varying degrees of renal damage depending on immune complex deposition in the glomeruli.
- Pathophysiology:
- Immune Complex Deposition: In conditions like PSGN and lupus nephritis, immune complexes deposit in the glomeruli, triggering inflammation and complement activation.
- Anti-GBM Antibodies: In Goodpasture syndrome, antibodies attack the glomerular basement membrane, causing both renal and pulmonary damage.
- Clinical Features:
- Hematuria: Commonly gross hematuria (cola-colored urine) or microscopic hematuria with dysmorphic red blood cells.
- Proteinuria: Usually sub-nephrotic (<3.5 g/day), though nephrotic range proteinuria may occur.
- Hypertension: Common due to fluid retention and glomerular injury.
- Edema: Frequently seen in the periorbital and dependent areas.
- Diagnosis:
- Urinalysis: Reveals hematuria, proteinuria, and red cell casts.
- Serologic Tests: ASO titers (PSGN), ANA (lupus nephritis), ANCA (vasculitis), and anti-GBM antibodies (Goodpasture syndrome).
- Renal Biopsy: Confirms diagnosis and determines the underlying cause.
- Management:
- Blood Pressure Control: ACE inhibitors or ARBs are used to manage hypertension and reduce proteinuria.
- Immunosuppressive Therapy: Corticosteroids and other immunosuppressants (e.g., cyclophosphamide) are indicated for immune-mediated GN (e.g., lupus nephritis, ANCA vasculitis).
- Supportive Care: Includes diuretics for edema and dialysis in severe renal impairment.
Key Points
- Glomerulonephritis presents with hematuria, proteinuria, hypertension, and edema.
- Primary causes include IgA nephropathy and MPGN, while secondary causes include PSGN and lupus nephritis.
- Diagnosis relies on urinalysis, serologic markers, and renal biopsy.
- Treatment involves blood pressure control, immunosuppressive therapy, and supportive care.