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KEY CONCEPTS

KEY CONCEPTS

  • Image not available. Glomerulonephritis is a collection of glomerular diseases mediated by different immunologic pathogenic mechanisms, resulting in varied clinical presentation and therapeutic outcomes.

  • Image not available. The signs and symptoms associated with glomerulonephritis are commonly nephrotic in nature and characterized by proteinuria. At times, there may be nephritic features, characterized by inflammatory injury.

  • Image not available. Supportive treatments for edema, hypertension, hyperlipidemia, and intravascular thrombosis are important in reducing the complications associated with glomerulonephritis. These are especially important since specific and effective therapy for many types of glomerulonephritis are not available. Reduction of proteinuria can often improve long-term kidney and patient outcomes.

  • Image not available. To maximize therapeutic benefits and minimize drug-induced complications, patients have to be monitored closely to assess their therapeutic responses as well as the development of any treatment-induced toxicities.

  • Image not available. Among all the types of glomerulonephritis, minimal-change nephropathy is most responsive to treatment. Steroids can induce good responses in most patients during initial treatment as well as relapse.

  • Image not available. Because of the lack of consistently effective treatment for primary focal segmental glomerular sclerosis, angiotensin-converting enzyme inhibitors or angiotensin receptor blockers are commonly used for patients with mild disease to control symptoms. Steroids and immunosuppressive agents are reserved for the management of patients with severe disease.

  • Image not available. The optimal treatment for lupus nephritis depends on the underlying lesion and disease activity, as well as the severity and duration of the patient’s condition.

  • Image not available. The treatment of poststreptococcal glomerulonephritis is mainly supportive and symptomatic. Antibiotic therapy does not prevent subsequent disease development but may reduce the severity.

The precise pathogenetic mechanisms of many glomerular diseases remain unknown and the available therapeutic regimens are still far from optimal. This chapter provides an overview of the primary causes of glomerulonephritis with a focus on their etiology, the pathophysiologic mechanisms responsible for glomerular injury, and the clinical presentation of the eight predominant types of glomerulonephritis. Treatment options and monitoring approaches for each type of glomerulonephritis are also discussed. Diabetes mellitus is an important secondary cause of glomerular injury and a thorough discussion of the pathophysiology and management of this condition can be found in Chapter 74.

NORMAL GLOMERULAR ANATOMY AND FUNCTION

The glomerulus, which is enclosed within the Bowman’s capsule, consists of two important components: the capillary wall and the mesangium (Fig. 47-1). The capillary wall, which serves as the primary filtration barrier, consists of three well-defined layers: fenestrated endothelium, glomerular basement membrane (GBM), and epithelial cell layer. The epithelial cells, also known as podocytes, have specialized foot processes embedded in the outer layer of the GBM. It is across this barrier that plasma water flows and ultimately becomes the ultrafiltrate. Under normal conditions, the GBM functions as a compact hydrated gel of matrix proteins with a pore-like structure. The mesangium, which consists of mesangial cells embedded in an extracellular matrix, provides support for the glomerular capillaries and also modulates blood flow through the capillaries.

FIGURE 47-1

Microanatomy of the ...

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