Acute Glomerulonephritis Management

Introduction to Acute Glomerulonephritis

Acute glomerulonephritis encompasses several distinct disorders, including post-streptococcal glomerulonephritis, infection-related GN, IgA nephropathy, ANCA-associated vasculitis, anti-GBM disease, lupus nephritis, and C3 glomerulopathy 1, 2, 3

The Kidney International guidelines suggest that post-streptococcal glomerulonephritis is the most common form of acute glomerulonephritis in developing countries, occurring 1-2 weeks after pharyngitis or 4-6 weeks after impetigo, although this fact is also reported by Praxis Medical Insights, the Kidney International guideline is preferred 6
Bacterial infection-related GN is associated with endocarditis, shunt infections, and other chronic bacterial infections, and may present with occult infection in 40% of cases 6
IgA nephropathy is characterized by disease flares and asymptomatic hematuria, according to the Kidney International guideline 1

For post-streptococcal glomerulonephritis, the Kidney International guideline recommends administering penicillin (or erythromycin if penicillin-allergic) even without active infection to decrease antigenic load, and using systemic antimicrobials during outbreaks to eliminate nephritogenic Streptococcus pyogenes strains from the community 6
For bacterial infection-related GN, the Kidney International guideline suggests treating the underlying infection aggressively with appropriate antimicrobials, and avoiding cyclophosphamide and rituximab in untreated HBV infection as they accelerate viral replication 6
The Kidney International guideline recommends performing kidney biopsy when diagnosis is uncertain or atypical presentation, C3 remains low beyond 12 weeks, or rapidly progressive glomerulonephritis with crescentic changes is suspected 6

The Kidney International guideline suggests monitoring kidney function (serum creatinine, eGFR), blood pressure control, urinalysis for hematuria and proteinuria, and electrolytes and acid-base status in the short-term (weekly to monthly) 6
In the long-term (8-12 weeks and beyond), the Kidney International guideline recommends monitoring C3 complement levels, which should normalize by 8-12 weeks in uncomplicated PSGN, and performing kidney biopsy if C3 remains low beyond 12 weeks to exclude C3GN 6