The Music of Glomerulonephritis; and the spectrum of glomerulonephritis (ANT). Links to Resources page.
Glomerulonephritis implies inflammation of glomeruli but usually means just upset glomeruli. Many types are believed to be autoimmune in origin. Two ends of a spectrum:
- Proteinuric diseases associated with damage to glomerular podocytes or mostly non-inflammatory architectural alterations to glomerular structure which upset podocytes. These cause proteinuria, which when severe causes nephrotic syndrome
- Diseases associated with inflammation and cell proliferation, and damage to glomerular cells and the GBM. Characterised by breaks in the GBM leading to haematuria as well as proteinuria. Severe disease may lead to rapid loss of renal function. Important examples:
|IgA nephropathy (Berger’s disease)||Common disease with extremely varied presentation usually including haematuria and hypertension. Often slowly evolving over decades, may lead to ESRF. In young, often acute exacerbations with similarities to post-streptococcal glomerulonephritis; or occurs with Henoch-Schonlein purpura and vasculitic changes in glomeruli, skin and bowel (usually self-limiting). IgA is deposited in mesangium of glomeruli. More on IgA disease from Edren|
|Post-Streptococcal glomerulonephritis||10-14 days after Streptococcal or other infection; associated with fluid retention, hypertension and oedema, usually remits spontaneously. Diffuse proliferation of cells on renal biopsy, with immune deposits. This disorder is uncommon in prosperous countries, common elsewhere.|
|Small vessel vasculitis||Usually associated with antibodies to neutrophil granule enzymes (ANCA); may cause aggressive but treatable nephritis, can be associated with severe vasculitis affecting lungs and other organs. More info from Edren.|
There are many other causes of glomerulonephritis. Many occupy the middle ground between the two presentations (nephrotic and nephritic) presented above. More detail in Further Info below.
- The spectrum of glomerulonephritis (medcal, tutorial/lecture series over 5 pages)
- Glomerulonephritis for patients (they get more info than there is here. You’d want that if you had it)
- What I tell my patients about glomerulonephritis (pdf file from the British Journal of Renal Medicine)
- Crescentic nephritis from Edren
- The glomerulus is a filter – historical perspective of discovery of how the glomerulus works, from the History of Nephrology blog