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  • image Glomerulonephritis is a collection of glomerular diseases mediated by different immunologic pathogenic mechanisms, resulting in varied clinical presentation and therapeutic outcomes.
  • image The signs and symptoms associated with glomerulonephritis can be nephritic in nature, characterized by inflammatory injury, or nephrotic in nature, characterized by proteinuria.
  • image In the absence of specific and effective therapy for many types of glomerulonephritis, supportive treatments for edema, hypertension, hyperlipidemia, and intravascular thrombosis play important roles in reducing the complications associated with the disease.
  • image 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 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 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 patients with severe disease.
  • image The optimal treatment for lupus nephritis depends on the underlying lesion and disease activity, as well as the severity and duration of the clinical presentation.
  • image The treatment of poststreptococcal glomerulonephritis is mainly supportive and symptomatic. Antibiotic therapy does not prevent subsequent diseases but may reduce the severity.

On completion of the chapter, the reader will be able to:

  1. Describe the normal anatomy and function of the glomeruli.

  2. Describe the pathogenesis of glomerular injury and pathologic manifestations of common types of glomerulonephritis.

  3. Describe the pathophysiology and etiology of the common types of glomerulonephritis.

  4. Describe the general clinical presentation of and diagnostic approach for glomerulonephritis.

  5. Describe the key differences between the nephritic and nephrotic syndrome.

  6. Describe the general approach for glomerulonephritis treatment.

  7. Describe the supportive therapy for edema, hypertension, proteinuria, hyperlipidemia, and coagulopathy.

  8. Describe the key parameters for treatment monitoring.

  9. Describe the key parameters for outcome evaluation.

  10. Describe the key concepts regarding pathophysiology, clinical presentation, and treatment for the following glomerulonephritis:

      1. minimal-change nephropathy

      1. focal segmental glomerulonephritis

      1. membranous nephropathy

      1. membranoproliferative glomerulonephritis

      1. immunoglobulin A nephropathy

      1. lupus nephritis

      1. rapidly progressive glomerulonephritis

      1. poststreptococcal glomerulonephritis

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 of these types 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 57.

The glomerulus, which is enclosed within the Bowman’s capsule, consists of two important components: the filtration barrier and the mesangium (Fig. 32-1). The capillary wall, which serves as a filtration ...

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