Glomerular diseases

Glomerular diseases include a group of urological disorders affecting the kidney apparatus and resulting in nephritic syndrome (inflammatory) and/or nephrotic syndrome (hemodynamic).

Nephritic syndrome is an inflammatory postinfectious renal disease affecting the glomeruli apparatus (nephrons and tubules), and often leading to glomerulonephritis, which is characterized by hematuria (red blood cells casts), hypertension (increased blood pressure, >140), renal insufficiency and edema (especially of the lower extremities). Moreover mild proteinuria (proteins and mainly albumins excreted in urine, <3g/M2/d), oliguria, and azotemia.

Nephritic syndrome may develop 1-6 weeks after a streptococcal infection.

Pathogenesis

Lesions in the glomeruli that are enlarged and hypercellular with neutrophils and later mononuclear cells. Epithelial hyperplasia causes microthrombosis and hemodynamic changes leading to oliguria and epithelial crescents showing in urine.

Increased protein/creatinine ratio <2 (normally it ranges between 0.1-0.3)

Protein > 0.5 < 2.5g/m2/day, Polychromasia (granular degeneration of the red blood cells), white blood cells casts (WBC casts).

Diagnosis

In case of chronic disease ultrasound diagnostics show relatively small kidneys, whereas in acute cases ultrasound shows normal to slightly enlarged kidneys.

Urine and blood tests.

Treatment

Lifestyle modifications, salt free (limitation of sodium intake to less than 1g/day), protein free diet.

Etiotropic therapy, wide spectrum antibiotics

Notice

If glomerulonephritis is caused by secondary causes, the classical clinical picture may be altered, and the patient may show systemic symptoms of other diseases, such as the clinical manifestations of uremia (hemolytic uremic syndrome).

Common symptoms of uremia include: nausea, vomit, dyspnea, pruritus, and chronic fatigue (relative to end-stage renal disease).

Nephrotic syndrome is a chronic renal disorder caused by increased glomerular permeability to plasma protein, the classical clinical picture includes:

1. Proteinuria > 2-2.5g/m2/day.
2. The protein/creatinine ration >2
3. Hypoalbuminemia <3g/dl
4. Generalized edema
5. Lipiduria (lipids in urine)
6. Lipemia (increased triglycerides and cholesterol levels in blood)

Treatment

1. Lifestyle modifications, high protein diet
2. ACE inhibitors, such as captopril (Capoten) or enalapril (Vasotec) are often used to reduce proteinuria and lipemia. However, ACE inhibitors may cause hyperkalemia.
3. Hypolipidemic drugs, such as simvastatin, a drug used to lower cholesterol and triglycerides.

Verified by: Dr.Diab (November 14, 2017)

Citation: Dr.Diab. (November 14, 2017). Glomerular diseases Nephrotic and Nephritic syndromes. Medcoi Journal of Medicine, 7(2). urn:medcoi:article16167.