Chronic Glomerulonephritis

By Christy Shubhangi

contents
Overview Pathophysiology Etiology Presentation and physical examination Laboratory studies Treatment

overview
Chronic glomerulonephritis is best considered a pool of end stage glomerular disease fed by a number of streams of specific types of glomerulonephritis. Meaning, nearly all forms of acute glomerulonephritis have a tendency to progress to chronic glomerulonephritis.

 The condition is characterized by irreversible and progressive glomerular and tubulointestinal fibrosis, ultimately leading to a reduction in GFR and retention of uremic toxins. If the disease progression is not halted with therapy , the net results are Chronic Kidney Disease(CKD), end stage kidney disease (ESKD) and cardiovascular disease.

Pathophysiology
Reduction in nephron mass from the initial injury reduces the GFR. This reduction leads to hypertrophy and hyper filtration of the remaining nephrons and to the initiation of intraglomerular hypertension.

 These changes occur in order ti increase the GFR of the remaining ne[hrons, thus minimizing the functional consequences of the nephron loss. The changes however leads to glomerulosclerosis and further nephron loss

Etiology
The progression from Acute glomerulonephritis to chronic glomerulonephritis is variable, depending on a considerable extent on the cause of the condition

Progression pattern
Rapidly progressive glomerulonepritis or crescentic glomerulonepritis- About 90% of patient progress to ESRD within weeks or month Focal segmental glomerulosclerosis:- about 80% of patient progress to ESRD in 10yrs Membranous nephropathy:- about 20-30% to chronic renal failure and ESRD in 10years

 Membranoproliferative glomerulonephritis:about 40% progress to Chronic renal failure and ESRD in 10years. IgA nephropathy:- About 10% progresses to ESRD in 10 years Poststreptococcal glomerulonephritis:- About 1-2% progress to CRF and ESRD in 10years

The thickness of the arrows reflects the approximate proportion of patients in each group who progress to chronic glomerulonephritis

Post streptococcal Chronic GN Rapidly progressive GN Chronic GN Membranous GN Chronic GN Focal glomerulosclerosis Chronic GN Membranoproliferative GN Chronic GN IgA nephropathy Chronic GN Others Chronic GN

Presentation and physical examination

Its always good to look for symptoms related to uremia such as Weakness and fatigue Pruritus Loss of energy, appetite and weight loss Early morning nausea and vomiting Reversal sleep pattern Seizures tremors

Lab studies
Urinalysis Complete blood count Urinary protein excretion Serum chemistry

Treatment
Pharmacologic therapy Renal Replacement Therapy Consultation Diet and Activity

 Thank You!!!