Complications
Acute kidney injury is more likely to occur with acute GN. Early diagnosis and treatment of diffuse and rapidly progressive disease is important. Some forms will result in chronic kidney disease despite therapy, ultimately requiring renal replacement (dialysis, transplant).
Fluid overload may occur due to reduced glomerular filtration rate (GFR) and increased tubular reabsorption of sodium.
Diuretics are the mainstay of therapy.
Seen more in nephrotic syndrome. It is likely the consequence of increased hepatic lipoprotein synthesis and loss of lipid-regulating proteins in urine. An increase in low-density lipoproteins and cholesterol is the commonest pattern. Lowering lipids may not necessarily be renoprotective but does prevent cardiovascular death. Initial treatment is with diet and exercise, followed by drug therapy.
Seen more in nephrotic syndrome. It is likely the consequence of increased hepatic lipoprotein synthesis and loss of lipid-regulating proteins in urine. An increase in low-density lipoproteins and cholesterol is the commonest pattern. Lowering lipids may not necessarily be renoprotective but does prevent cardiovascular death. Initial treatment is with diet and exercise, followed by drug therapy.
Associated with lupus (antiphospholipid antibody) and nephrotic syndrome (urinary loss of antithrombin III, altered levels of protein C and S, increased platelet aggregability). Anticoagulation may be required in selected patients.
Related to increased urinary loss and catabolism of immunoglobulins, or may be related to treatment with corticosteroids and immunosuppressants.
Antibiotic prophylaxis may be required to prevent opportunistic infections such as Pneumocystis pneumonia in patients receiving cyclophosphamide.[48]
Patients should be up to date with their vaccination schedule.
Most patients with GN will have hypertension as a result of impaired estimated GFR and increased reabsorption of salt and water. If uncontrolled, this would predispose to cardiovascular disease. A low-salt diet and exercise can be attempted initially. Treatment with diuretics, ACE inhibitors, or an angiotensin-II receptor antagonist is preferred because of their effects on fluid retention and proteinuria. Multidrug therapy will often be needed.
A higher predisposition may be related to hypertension, hypervolemia, and hyperlipidemia, or the underlying disease may affect the coronary arteries independently.
Principal determinants of a relatively poor renal outcome include more severe renal dysfunction at presentation, more severe proteinuria, lack of response to initial treatment, and an enhanced amount of fibrotic changes, such as interstitial fibrosis on initial kidney biopsy.
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