GlomerulonephritisEdit

Glomerulonephritis is a family of disorders characterized by inflammation of the glomeruli, the microscopic filters of the kidney. These conditions can appear suddenly or evolve over time, and their course ranges from self-limited illnesses to chronic kidney disease that eventually requires dialysis or transplantation. The inflammation is typically immune-mediated, involving immune complex deposition, autoantibodies, and activation of the complement system, which disrupts normal filtration and can produce symptoms such as hematuria (blood in the urine), proteinuria (protein in the urine), edema, and elevated blood pressure. The scope of glomerulonephritis includes primary kidney diseases and secondary conditions tied to systemic illnesses such as autoimmune diseases or infections. Diagnosis and management rely on careful clinical assessment, laboratory testing, and, in many cases, kidney biopsy to define the pattern of injury and tailor therapy. glomerulonephritis kidney nephrology hematuria proteinuria kidney biopsy

The classification of glomerulonephritis reflects differences in pathophysiology and histology. Broadly, diseases are grouped as nephritic syndromes, nephrotic syndromes, or mixed presentations, and they can be further divided into primary kidney diseases and secondary manifestations of systemic disorders. Common examples include acute postinfectious glomerulonephritis typically following infections such as streptococcal throat or skin infections; IgA nephropathy (Berger disease), often presenting with recurrent hematuria; membranous nephropathy; focal segmental glomerulosclerosis (FSGS); membranoproliferative changes; and lupus nephritis, which occurs in systemic lupus erythematosus. Each type has characteristic clinical features, laboratory findings, and responses to treatment, emphasizing the importance of precise diagnosis. acute poststreptococcal glomerulonephritis IgA nephropathy lupus nephritis membranous nephropathy focal segmental glomerulosclerosis nephritic syndrome nephrotic syndrome systemic lupus erythematosus glomerulonephritis

Clinical presentation is diverse. Nephritic-pattern diseases commonly cause red or cola-colored urine, modest to marked hematuria, variable proteinuria, hypertension, edema, and sometimes reduced kidney function. Nephrotic-pattern diseases tend to produce heavy proteinuria, hypoalbuminemia, swelling (especially around the eyes and in the legs), and high cholesterol, with less dramatic hematuria. Some patients have mixed features or episodic flares. Because the underlying causes span infections, autoimmune processes, and chronic diseases, a thorough workup—urinalysis, serum creatinine and estimated glomerular filtration rate (eGFR), electrolyte panel, serologies for autoimmune disease, complements, and possibly imaging—is essential. In many cases a renal biopsy is needed to determine the exact glomerular lesion and guide therapy. urinalysis creatinine eGFR complement renal biopsy glomerulonephritis

Diagnosis and monitoring hinge on understanding the pattern of injury and the underlying cause. Key diagnostic steps include assessing the level of protein in the urine, the degree of kidney function, blood pressure control, and the presence of systemic signs such as rash or joint symptoms that might point to a systemic autoimmune disease. Serologic tests can help identify postinfectious etiologies, autoimmune diseases, and infectious triggers. Imaging, when used, mainly serves to evaluate kidney size and anatomy and to rule out alternative explanations for kidney dysfunction. Treatment is individualized, aiming to reduce ongoing inflammation, protect kidney function, and manage complications such as high blood pressure and edema. proteinuria hypertension nephritic syndrome nephrotic syndrome autoimmune disease renal imaging ACE inhibitor Angiotensin II receptor blocker steroids immunosuppressive therapy cyclophosphamide rituximab

Management strategies emphasize both disease-specific therapy and general kidney-protective care. For many immune-mediated glomerulonephritides, controlling the immune response with corticosteroids or other immunosuppressive agents is appropriate, but this must be balanced against side effects and long-term risks. Supportive care includes blood pressure control with agents such as ACE inhibitors or ARBs, which also reduce proteinuria and slow progression of kidney disease, as well as sodium restriction, diuretics for edema, and careful fluid management. In cases of nephrotic-range proteinuria or progressive kidney dysfunction, more aggressive immunosuppression or targeted therapies may be indicated, guided by biopsy results and clinical judgment. When kidney function declines to the point of end-stage disease, renal replacement therapy with dialysis or kidney transplantation becomes relevant options. ACE inhibitor Angiotensin II receptor blocker steroids immunosuppressive therapy renal replacement therapy dialysis kidney transplantation nephrotic syndrome nephritic syndrome IgA nephropathy lupus nephritis

Controversies and policy considerations surround the balance between aggressive treatment, costs, and patient autonomy. Clinicians debate when to escalate immunosuppressive therapy in diseases such as IgA nephropathy or membranous nephropathy, weighing potential kidney-sparing benefits against systemic risks and long-term costs. Critics of overuse argue that more intervention is not always better care and that treatment decisions should be guided by solid evidence of meaningful benefit, especially given the side effects of potent drugs. From a resource-management perspective, there is ongoing discussion about how to allocate finite health-care funds efficiently, ensuring that high-value therapies are accessible while avoiding saturation of the system with low-benefit interventions. Proponents of evidence-based care emphasize monitoring outcomes, conducting cost-benefit analyses, and tailoring therapy to individual risk profiles. Some critics describe broad, blanket calls for universal, unrestricted access to every therapy as impractical or unsustainable; supporters respond that patient access should be prioritized where the medical benefit is clear and the cost is justified by outcomes. In any case, the debate centers on medical necessity, value, and the incentives created by health insurance design and public funding. See also healthcare policy cost-effectiveness rituximab cyclophosphamide nephrology renal replacement therapy dialysis kidney transplantation

See also - nephrology - kidney - hematuria - proteinuria - renal biopsy - ACE inhibitor - Angiotensin II receptor blocker - steroids - immunosuppressive therapy - cyclophosphamide - rituximab - dialysis - kidney transplantation - nephrotic syndrome - nephritic syndrome - IgA nephropathy - lupus nephritis - focal segmental glomerulosclerosis