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