When the amount of proteins excreted in the urine exceeds the livers ability to compensate, fewer proteins are detected in the blood – in particular albumin, which makes up the majority of circulating proteins. With decreased proteins in the blood, there is a decrease in the oncotic pressure of the blood. This results in edema, as the oncotic pressure in tissue remains the same. Although decreased intravascular oncotic (i.e. osmotic) pressure partially explains the patients edema, more recent studies have shown that extensive sodium retention in the distal nephron (collecting duct) is the predominant cause of water retention and edema in the nephrotic syndrome. This is worsened by the secretion of the hormone aldosterone by the adrenal gland, which is secreted in response to the decrease in circulating blood and causes sodium and water retention. Hyperlipidemia is thought to be a result of the increased activity of the liver. : 549

Nephritic syndrome
The nephritic syndrome is characterised by blood in the urine (especially Red blood cell casts with dysmorphic red blood cells) and a decrease in the amount of urine in the presence of hypertension. In this syndrome, inflammatory damage to cells lining the glomerulus are thought to result in destruction of the epithelial barrier, leading to blood being found in the urine. At the same time, reactive changes, e.g. proliferation of mesangial cells, may result in a decrease in kidney blood flow, resulting in a decrease in the production of urine.
Rapid growing and fibrosis of crescents compresses the capillary loops and decreases the Bowman space, which leads to kidney failure within weeks or months. Diagnosis
Some forms of glomerulonephritis are diagnosed clinically, based on findings on history and examination. Other tests may include:
Urine examination
Blood tests investigating the cause, including FBC, inflammatory markers, and special tests (including ASLO, ANCA, Anti-GBM, Complement levels, Anti-nuclear antibodies)
Biopsy of the kidney
Renal ultrasonography is useful for prognostic purposes in finding signs of chronic kidney disease, which however may be caused by many other diseases than glomerulonephritis. Treatment
Antibiotic therapy to prevent streptococcal infection (prophylaxis). Steroids to suppress inflammation. Provide high calories & low protein, sodium & potassium diet. Monitor for sign of kidney failure, heart failure, and hypertensive encephalopathy. See also
Nephritic syndrome
Nephritis
Lupus nephritis
Rapidly progressive glomerulonephritis

References


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