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Chronic Glomerulonephritis

Chronic glomerulonephritis can be caused by various intrinsic glomerular diseases (primarily of autoimmune origin) and by numerous systemic disorders that target the glomeruli. Two main clinical entities arise - nephritic syndrome and nephrotic syndrome, mainly distinguished by the presence of hematuria in the former and larger quantities of protein loss (>3.5 g/day) in the latter, respectively. A comprehensive laboratory workup, including determination of the glomerular filtration rate (GFR), is necessary to determine the severity of kidney disease and confirm the underlying cause.


Presentation

Chronic glomerulonephritis denotes a progressive deterioration of kidney function and is one of the main factors involved in the pathogenesis of chronic kidney disease (CKD) [1] [2]. It may be defined as a persistent and long-lasting inflammatory disorder of the glomeruli and is almost universally a complication of acute glomerulonephritis, distinguished by a slower progression and a milder clinical presentation [2]. A broad classification of ailments that cause glomerulonephritis can be mainly based on the two clinical syndromes produced by these etiologies [1] [2] [3] [4] [5]:

  • Nephritic syndrome - Oliguria (reduced urine output), macroscopic hematuria (tea-colored urine), and hypertension are clinical hallmarks of nephritic syndrome, which typically develops due to an ongoing immunological process, thus it may be seen in both acute and chronic glomerulonephritis [1] [2]. Intrinsic renal diseases that induce this syndrome are poststreptococcal glomerulonephritis (PSGN), anti-glomerular basement membrane (anti-GBM) disease, but also immunoglobulin A (IgA) nephropathy (known as Buerger's disease), regarded as the most common etiology of glomerulonephritis in the world [1] [4]. Focal segmental glomerulosclerosis (FSGS), membranoproliferative GN, and IgA nephropathy are particularly associated with hypertension [5] [6]. In addition, systemic lupus erythematosus (SLE) and anti-neutrophil cytoplasmic antibody (ANCA) vasculitis are notable systemic causes [1] [2].
  • Nephrotic syndrome - Contrary to the nephritic syndrome, minimal or no inflammation is present and marked impairment of the glomerular capacity to perform the process of filtration is the main pathological event [1]. Profound proteinuria (>3.5 g/day) resulting in hypoalbuminemia and consequent edema are prominent symptoms, whereas hypertension and vascular abnormalities are absent in the initial stages of the illness [1] [3]. However, intrinsic disorder of the kidney that causes nephritic syndrome may also induce nephrotic syndrome, such as FSGS and IgA nephropathy, while minimal change disease (MCD), diabetic nephropathy, systemic disorders (amyloidosis, SLE), and several other entities have been described in the pathogenesis of nephrotic syndrome [1] [2] [3].
Hypertension
  • In both patients normal-sized kidneys were demonstrated in addition to vascular bruits and Grade III hypertensive retinopathy.[ncbi.nlm.nih.gov]
  • The prevalence of hypertension was 42%.[ncbi.nlm.nih.gov]
  • Abstract Hypertension in chronic progressive renal disease is a major clinical problem leading to renal function loss.[ncbi.nlm.nih.gov]
  • The results were compared to those obtained in ten patients with unilateral renovascular hypertension (RVH), eleven patients with essential hypertension (EH), and in eleven normal subjects (NS).[ncbi.nlm.nih.gov]
  • KEYWORDS: Blood pressure; Chronic glomerulonephritis; Gene polymorphism; Hypertension; Renal survival Publication type, MeSH terms, Substances Publication type Research Support, Non-U.S.[ncbi.nlm.nih.gov]
Hypertensive Retinopathy
  • In both patients normal-sized kidneys were demonstrated in addition to vascular bruits and Grade III hypertensive retinopathy.[ncbi.nlm.nih.gov]
Amenorrhea
  • Abstract A 28-year-old woman had hypothalamic disorders (amenorrhea, obesity, psychiatric abnormalities, polydipsia and fever) and chronic glomerulonephritis. She also suffered from general edema associated with cyclical oliguria and polyuria.[ncbi.nlm.nih.gov]

Workup

The diagnosis of chronic glomerulonephritis may be difficult to make in its initial stages due to an asymptomatic or milder clinical course [2], which is why a thorough workup is imperative. The physician must obtain a detailed patient history that will address the appearance of macroscopic hematuria, hypertension, or peripheral edema. History of drug use is essential during the interview since non-steroidal anti-inflammatory drugs (NSAIDs), oral contraceptives, and penicillamine (a chelating agent) have been listed as iatrogenic causes of glomerulonephritis [1]. Infections are an important etiology of glomerulonephritis as well, such as viral hepatitis (B and C), human immunodeficiency virus (HIV) infection, and many other bacterial/viral/fungal pathogens [1] [2], which is why the presence of additional symptoms must be assessed. Laboratory studies, however, are crucial for diagnosing chronic glomerulonephritis. Evaluation of serum electrolytes and creatinine, together with urinalysis for hematuria and protein content are key steps for identifying renal function abnormalities [1] [2]. The role of urinalysis is further strengthened by the fact that a significant number of patients are asymptomatic when microscopic hematuria is detected [7]. The glomerular filtration rate (GFR), considered to be the main indicator of renal function, can be calculated based on either serum creatinine levels (together with other components required for the calculation, such as age and gender) [1] [8]. A full immunological workup (antinuclear antibody test, antineutrophil cytoplasmic antibodies test, anti-double-stranded DNA test, complement component 3 exam), ultrasonography, and eventually a renal biopsy might be necessary in order to confirm the underlying cause of chronic glomerulonephritis [1] [2].

Bilateral Small Kidneys
  • small kidneys Microscopic (histologic) description Glomerulosclerosis, tubular atrophy and thyroidization, interstitial fibrosis and lymphocytic inflammation Arterial and arteriolar sclerosis Microscopic (histologic) images Images hosted on other servers[pathologyoutlines.com]
Small Kidney
  • kidneys with thin granular cortex and increased peripelvic fat Gross images Images hosted on other servers: Due to hypertension Chronic glomerulonephritis Bilaterally small kidneys Microscopic (histologic) description Glomerulosclerosis, tubular atrophy[pathologyoutlines.com]
Creatinine Increased
  • Some authors have found that persistent hypertension, serum creatinine increase at diagnosis, and macroscopic hematuria episodes are also related to worse prognosis.[kidneypathology.com]
Amino Acids Increased
Glucagon Increased
  • ANP and glucagon increased equally in both groups. Most amino acids increased two- or threefold.[ncbi.nlm.nih.gov]

Treatment

  • In 10 eyes of 5 children with multiple hospitalizations and pulse treatments, a temporary decrease in CT was observed with methylprednisolone pulse treatment and after recovery without methylprednisolone pulse treatment.[ncbi.nlm.nih.gov]
  • After 8 weeks of treatment, the treatment group and the control group showed a mean reduction in 24-h proteinuria of 34.81% and 37.66%. The 95% CI of difference of the mean reduction in 24-h proteinuria between the two groups was [-11.50%, 5.80%].[ncbi.nlm.nih.gov]
  • […] occurred at a similarly low rate in the treatment group (0.4%) and control group (1.2%, P 0.3724).[ncbi.nlm.nih.gov]
  • Glucocorticoids significantly reduced BMD of the lumbar spine in the 6 month treatment period (p 0.01).[ncbi.nlm.nih.gov]
  • The most common combined pathogenetic treatment regimens for the treatment of chronic glomerulonephritis are the object of the present study.[ncbi.nlm.nih.gov]

Prognosis

  • CONCLUSIONS: The authors think that at present the combined pathogenetic treatment of chronic glomerulonephritis has no alternative and can slow the progression of the renal injury as well as influence favorably the short- and long-term prognosis of the[ncbi.nlm.nih.gov]
  • What is the Prognosis of Chronic Glomerulonephritis? (Outcomes/Resolutions) The prognosis of Chronic Glomerulonephritis depends on the severity of the signs and symptoms.[dovemed.com]
  • There will be a decrease in GFR • Prognosis varies depending upon the specific cause, but spontaneous recovery generally occurs after the acute illness Chronic glomerulonephritis (CGN) Can occur in a patient without a previous history or known onset •[quizlet.com]
  • Identification of the histological appearance is of high importance in CGN prognosis because of their different manifestations and tendency to relapse.[link.springer.com]
  • Lyubov , Bairova Tatyana , Kolesnikova Lyubov Scientific Centre for Family Health and Human Reproduction Problems, Irkutsk, Russia Abstract Background Kidney diseases are the common cause of secondary hypertension in children, which predetermines dismal prognosis[adc.bmj.com]

Etiology

  • Infections are an important etiology of glomerulonephritis as well, such as viral hepatitis (B and C), human immunodeficiency virus (HIV) infection, and many other bacterial/viral/fungal pathogens, which is why the presence of additional symptoms must[symptoma.com]
  • We believe this case is the first to show the etiology of pseudotumor as an extremely uncommon manifestation of chronic glomerulonephritis by histologic examination.[ncbi.nlm.nih.gov]
  • These findings raised the suspicion of an etiological condition other than chronic glomerulonephritis underlying the hypertension and renal failure. Renal angiography revealed bilateral severe renal artery stenosis.[ncbi.nlm.nih.gov]
  • MeSH terms Adult Aryldialkylphosphatase/genetics* Case-Control Studies Chronic Disease Endothelin-1/genetics* Female Glomerulonephritis/complications Glomerulonephritis/genetics* Glomerulonephritis/mortality* Homeostasis/genetics Humans Hypertension/etiology[ncbi.nlm.nih.gov]
  • Few glomeruli may still present changes which permit to discern the etiology of chronic glomerulonephritis.[pathologyatlas.ro]

Epidemiology

  • It was compared to a control group of 7,468 subjects who were obtained from an epidemiologic study performed in the same area at the same period. The prevalence of hypertension was 42%.[ncbi.nlm.nih.gov]
  • BACKGROUND: There is a paucity of epidemiological data on biopsy-proven glomerulonephritis (GN) in Poland.[ncbi.nlm.nih.gov]
  • Currently, practical guidelines recommend using Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equations to assess GFR in CKD patients. Methods: A cross-sectional study was performed in CGN patients.[dovepress.com]
  • One study reported a change in the epidemiology of APSGN and found that pharyngitis has replaced impetigo as the predominant cause of APSGN. [10] International APSGN can occur sporadically or epidemically.[emedicine.medscape.com]
  • Summary Epidemiology It is a very rare disease. The exact prevalence is unknown. Only 16 families have been described in the literature so far.[orpha.net]
Sex distribution
Age distribution

Pathophysiology

  • CONCLUSION: Our findings suggest that U-II may have a possible autocrine/paracrine function in the kidneys, and may be an important target molecule in studying renal pathophysiology.[ncbi.nlm.nih.gov]
  • Increased endogenous NO production may play some pathophysiological role in these patients.[ncbi.nlm.nih.gov]
  • Till now it has been postulated that underlying pathophysiology in aHUS is chronic, uncontrolled activation of the complement system.[bloodjournal.org]
  • What is the Pathophysiology of glomerulonephritis? A.[proprofs.com]

Prevention

  • Menatetrenone is a useful agent in preventing prednisolone-induced loss of BMD.[ncbi.nlm.nih.gov]
  • C4NeF prevented the intrinsic decay of C4b2a enzyme and prolonged the half life of the C4b2a from several minutes to more than 1 h in the solid and fluid phase.[ncbi.nlm.nih.gov]
  • OBJECTIVE: To observe the effect of yishen capsule (YSC) on preventing the recurrence of chronic glomerulonephritis (CGN) and to explore its mechanism preliminarily.[ncbi.nlm.nih.gov]
  • In conclusion L-arginine reduces protein-excretion without significant alterations in renal hemodynamics and so might prevent a decline in renal failure.[ncbi.nlm.nih.gov]
  • CLINICAL RELEVANCE: For effective measures of prevention and improvement of oral health in HD patients, clinicians should be aware of the differences in the characteristics of the oral health between patients undergoing HD for DN and CGN.[ncbi.nlm.nih.gov]

References

Article

  1. Isbel NM. Glomerulonephritis--management in general practice. Aust Fam Physician. 2005;34(11):907-913.
  2. Porter RS, Kaplan JL. Merck Manual of Diagnosis and Therapy. 19th Edition. Merck Sharp & Dohme Corp. Whitehouse Station, N.J; 2011.
  3. Lewis G, Maxwell AP. Timely diagnosis and treatment essential in glomerulonephritis. Practitioner. 2015;259(1779):13-7, 2.
  4. Kawasaki Y. Mechanism of onset and exacerbation of chronic glomerulonephritis and its treatment. Pediatr Int. 2011;53(6):795-806.
  5. Sethi S, Nester CM, Smith RJH. Membranoproliferative Glomerulonephritis and C3 Glomerulopathy: Resolving the Confusion. Kidney Int. 2012;81(5):434-441.
  6. Ihm C-G. Hypertension in Chronic Glomerulonephritis. Electrolyte Blood Press. 2015;13(2):41-45.
  7. Chadban SJ, Briganti EM, Kerr PG, et al. Prevalence of kidney damage in Australian adults: the AusDiab kidney study. J Am Soc Nephrol. 2003;14:S131–138.
  8. Levey AS, Eckardt KU, Tsukamoto Y, et al. Definition and classification of chronic kidney disease: a position statement from Kidney Disease: Improving Global Outcomes (KDIGO). Kidney Int. 2005 Jun;67(6):2089-100.

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Last updated: 2018-06-21 21:09