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21.3 Glomerular Diseases (GN)

Table of Contents

Are those which cause glomerular to leak blood or protein into urine. Glomerular disease may be a result of a primary condition of the kidney, or may be secondary to a systemic disorder.

Diagnostic Criteria

  • Proteinuria
  • Reduced GFR (and its effects)
  • Haematuria
  • Hypertension
  • Oedema.

21.3.1 Glomerular disease – Nephritic syndrome

A non infectious inflammatory process that involve the nephron.

Diagnostic Criteria:

  • Painless macroscopic turbid, bloody or brownish urine
  • Peripheral and facial oedema
  • Difficulty in breathing
  • Hypertension encephalopathy with impaired level of consciousness or convulsions
  • Little or no urine excretion

Investigations

  • Renal function test
  • Urinalysis
  • Urine culture
  • Complete blood count
  • Others on tertiary hospital e.g. lupus serology, complements

Non Pharmacological Treatment

  • Give oxygen, and nurse in semi-Fowlers position if patient has respiratory distress.
  • Restrict intake of all salt
  • Restrict potassium containing foods and fluids
  • Restrict fluid intake to 10 mL/kg/day daily plus visible fluid losses

Pharmacological treatment

Adults

Fluid overload

B: Furosemide I.V bolus, 80 mg.

If hypertension

If diastolic blood pressure is greater than 100 mmHg or systolic blood pressure is above

150 mmHg:

C: Amlodipine 5 mg (PO) as a single dose

Note: The definitive treatment of nephritis depends on the cause – an assumption of acute post streptococcal nephritis or any other disease cannot be made without specific investigation which may include renal biopsy.

21.3.2 Nephrotic syndrome

It is a renal disorder characterized by urinary protein loss leading to generalized body swelling.

It is severe proteinuria defined as: Adults: 2.5 g/day,

Diagnostic Criteria

  • Oedema
  • Hypoalbuminaemia
  • Hyperlipidaemia

Note: Accurate diagnosis requires a renal biopsy

Non-Pharmacological Treatment

Adequate calories and adequate protein 1g/kg/d

No added salt to limit fluid overload

Pharmacological Treatment

The management of glomerular disease depends on the type/cause of the disease and is individualized guided by a specialist according to the biopsy result.

Note: Referral to nephrologist may include treatment using immunosuppressant such as prednsolone, mycophenolate mofetil, cyclophosphamide, angiotensin blockade etc

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