Acute Glomerulonephritis (Glomerulonephritis)

Acute Glomerulonephritis – Treatment Options

Introduction
Acute glomerulonephritis (AGN) is a sudden onset of glomerular inflammation, commonly following infections (e.g., post-streptococcal GN), autoimmune disorders (lupus nephritis, IgA nephropathy), or systemic vasculitides. It presents with hematuria, proteinuria, hypertension, edema, and varying degrees of renal impairment. Management focuses on supportive care, controlling complications, and treating underlying causes.

1. General and Supportive Measures

• Fluid and salt restriction: To control hypertension and edema.

• Diuretics (loop diuretics such as furosemide): For fluid overload and hypertension.

• Antihypertensives: ACE inhibitors/ARBs if tolerated (though caution in acute renal impairment); calcium channel blockers as alternatives.

• Bed rest: Recommended during acute severe episodes to reduce metabolic demand.

2. Management of Underlying Causes

• Post-streptococcal glomerulonephritis:

  • Penicillin (or appropriate antibiotic) to eradicate streptococcal infection.

  • Supportive care as most cases are self-limiting.

• Autoimmune causes (e.g., lupus nephritis, ANCA-associated vasculitis, anti-GBM disease):

  • Corticosteroids ± immunosuppressive agents (cyclophosphamide, rituximab, mycophenolate mofetil).

• IgA nephropathy:

  • Supportive care (BP and proteinuria control).

  • Immunosuppression considered in rapidly progressive forms.

3. Specific Therapies in Severe Cases

• Plasmapheresis: Indicated in anti-GBM disease (Goodpasture’s syndrome) or severe rapidly progressive glomerulonephritis with pulmonary hemorrhage.

• Immunosuppressive regimens: High-dose IV methylprednisolone pulses followed by oral taper; often combined with cytotoxic agents.

• Dialysis: For severe renal impairment, refractory fluid overload, or electrolyte imbalance.

4. Monitoring and Complication Management

• Renal function: Serial monitoring of serum creatinine, urea, and electrolytes.

• Urine studies: Proteinuria and hematuria assessment.

• Blood pressure: Aggressive management to prevent progression to chronic kidney disease (CKD).

• Anemia and metabolic bone disease: Addressed if chronic renal involvement develops.

5. Lifestyle and Preventive Measures

• Low-sodium diet to reduce edema and blood pressure.

• Adequate protein intake (not excessive, to reduce renal strain).

• Avoidance of nephrotoxic drugs (NSAIDs, aminoglycosides).

• Regular follow-up to detect progression to CKD or relapse.

6. Multidisciplinary Care

• Nephrologists: For diagnosis, biopsy interpretation, and immunosuppressive management.

• Rheumatologists: In systemic autoimmune causes.

• Critical care specialists: For severe renal failure or hypertensive emergencies.

• Dialysis teams: If renal replacement therapy is required.