What are the guideline sources, guidelines and references for Infection-related glomerulonephritis ?
Guideline sources The following summarized guidelines for the evaluation and management of infection-related glomerulonephritis are prepared by our editorial team based on guidelines from the Kidney Disease: Improving Global Outcomes Foundation (KDIGO 2021). 1 Guidelines 1. Classification and risk stratification Risk factors: Recognize the risk features of different etiologies of infection-related glomerulonephritis: Situation Guidance Children, elderly, immunocompromised host, low socioeconomic status Postinfectious glomerulonephritis Ventriculoatrial (highest), ventriculojugular (mid), ventriculoperitoneal (least) Shunt nephritis https://web.pathway.md/diseases/rec2sn0ARz4XRhj5o 1/5 6/24/23, 2:34 PM Infection-related glomerulonephritis Pathway Endocarditis-related glomerulonephritis Prosthetic valve or structural heart valve lesion, substance abuse, elderly, diabetes mellitus, HCV, human immunodeficiency virus Immunocompromised host Diabetes mellitus, hypertension, heart disease, malignancy, alcohol or substance abuse, or kidney transplantation. B IgA-dominant infection-related glomerulonephritis Prognosis: Recognize the following prognostic outcomes of infection-related glomerulonephritis: Situation Guidance Short-term prognosis in pediatric patients is excellent Postinfectious glomerulonephritis Persistent albuminuria may occur and some adult patients develop low estimated GFR in endemic regions Kidney prognosis is poor in elderly patients with persistent albuminuria, with a mortality rate of up to 20% Dialysis is frequently required in the acute setting IgA-dominant infection-related glomerulonephritis Recovery is guarded, with < 20% returning to premorbid levels of kidney function Prognosis is poor in diabetic patients Immediate prognosis is good with prompt infection eradication Endocarditis-related glomerulonephritis Some patients may require valve replacement Outcome is good with early diagnosis and treatment of infection Shunt nephritis Most patients recover some kidney function but are left with residual CKD (Practice Point). B 2. Diagnostic investigations https://web.pathway.md/diseases/rec2sn0ARz4XRhj5o 2/5 6/24/23, 2:34 PM Infection-related glomerulonephritis Pathway History and physical examination: elicit a history of an antecedent resolved pharyngitis (1-2 weeks) or impetigo (4-6 weeks) in patients with suspected postinfectious glomerulonephritis. Recognize that some patients have active skin or tonsil infections present. B Show 3 more Laboratory tests: obtain urinalysis, assess for glomerular hematuria and RBC casts, and measure albumin-creatinine ratio, protein-creatinine ratio, and serum creatinine/estimated GFR in patients with suspected infection-related glomerulonephritis. B Show 6 more Echocardiography: obtain echocardiography to assess for evidence of cardiac valvular vegetations in patients with suspected endocarditis-related glomerulonephritis. B 3. Diagnostic procedures Kidney biopsy: consider performing kidney biopsy in patients with suspected bacterial infection- related glomerulonephritis, particularly when culture evidence of infection is elusive or the diagnosis is in doubt, to assess prognosis, and/or for potential therapeutic reasons, as well as to establish the correct diagnosis in some circumstances where comorbidities contribute to confounding effects. C 4. Medical management General principles: treat edema and hypertension, as well as persistent proteinuria and/or progressive GFR decline as per glomerulonephritis guidelines. B Antimicrobial therapy: Initiate antibiotics for underlying infection according to pertinent guidelines, although recognizing that this will not alter the glomerulonephritis course in postinfectious glomerulonephritis. B Consider initiating antibiotics in patients with poststreptococcal glomerulonephritis if streptococci are cultured from any site, primarily to prevent the spread of infection within community sites. C Immunosuppressive therapy: insufficient evidence to support the use of corticosteroids in patients with postinfectious glomerulonephritis. I Show 2 more 5. Specific circumstances Patients with viral infection-related GN (HBV): test for HBV infection in patients with proteinuric glomerular disease. B Show 7 more Patients with viral infection-related GN (HIV): perform a kidney biopsy, when feasible, to evaluate the morphology of human immunodeficiency virus-related kidney disease. Ensure a https://web.pathway.md/diseases/rec2sn0ARz4XRhj5o 3/5 6/24/23, 2:34 PM Infection-related glomerulonephritis Pathway pathology-based description of human immunodeficiency virus-related kidney disease to help define and guide therapy. B Show 3 more Patients with parasite-related GN (schistosomiasis): test for appropriate endemic coinfections (Salmonella, HBV, HCV, human immunodeficiency virus), as targeted treatment may alter the aggressiveness of underlying glomerulonephritis or the sequela of schistosomiasis. B Show 5 more Patients with parasite-related GN (filariasis): initiate an appropriate antiparasitic agent in sufficient dosage and duration to eradicate the organism n patients with filarial infection and glomerulonephritis. B Patients with parasite-related GN (malaria): Initiate an appropriate antiparasitic agent in sufficient dosage and duration to eradicate the organism from blood and hepatosplenic sites in patients with malarial infection and glomerulonephritis. B Do not use immunosuppressive agents in patients with malarial nephropathy. D 6. Preventative measures Prevention of epidemic poststreptococcal GN: consider implementing socioeconomic interventions and mass antimicrobial use to improve living conditions and limit the spread of infection to prevent epidemic poststreptococcal glomerulonephritis in populations where group A streptococcus infection and scabies are highly prevalent. C 7. Follow-up and surveillance Serial laboratory assessment: Follow kidney function, measure serum C3 and C4 levels, obtain urinalysis, and assess albumin-creatinine ratio and proteinuria at appropriate intervals until complete remission or return to baseline. B Consider performing kidney biopsy in postinfectious glomerulonephritis with persistently low C3 beyond 12 weeks, to particularly exclude C3 glomerulonephritis. C References 1. Kidney Disease: Improving Global Outcomes KDIGO Glomerular Diseases Work Group. KDIGO 2021 Clinical Practice Guideline for the Management of Glomerular Diseases. Kidney Int. 2021 Oct;100 4S S1 S276. Open 2. Kidney Disease: Improving Global Outcomes KDIGO Hepatitis C Work Group. KDIGO 2018 Clinical Practice Guideline for the Prevention, Diagnosis, Evaluation, and Treatment of Hepatitis C in Chronic Kidney Disease. Kidney Int Suppl 2011 . 2018 Oct;8 3 91 165. Open https://web.pathway.md/diseases/rec2sn0ARz4XRhj5o 4/5 6/24/23, 2:34 PM Infection-related glomerulonephritis Pathway https://web.pathway.md/diseases/rec2sn0ARz4XRhj5o 5/5