(III) Clinical manifestations of glomerulonephritis:
Patient with glomerulonephritis may present with any of the
following five syndromes:
- Nephrotic syndrome:
This is characterized clinically with massive oedema of insidious
onset. In some cases, it may progress slowly to renal failure. Urine
analysis shows massive proteinuria (> 3.5 gm/24 hr/1.73 m^2 ),
microscopic haematuria and lipiduria. Serum analysis may show
hypoalbuminaemia and hypercholesterolaemia. Serum creatinine is
usually normal. - Acute nephritic syndrome (acute nephritis):
Characterized clinically with rapid onset of oedema (less in severity
than in nephrotic syndrome), oliguria and hypertension. Urine
analysis may show red cell casts, proteinuria (less in amount than in
nephrotic syndrome), haematuria and leukocyturia. Serum analysis
may show increased serum creatinine, normal serum albumin and
cholesterol. Prognosis is usually good and recovery occurs. - Rapidly progressive glomerulonephritis (RPGN):
Characterized clinically with rapid (within days to weeks) loss of
kidney function with development of manifestations of uraemia and
the patient needs dialysis treatment. If not treated early and
aggressively, the renal damage may be irreversible. Urine analysis
may show findings which are similar to acute nephritic syndrome.
Serum analysis shows rapidly increasing serum creatinine while
serum albumin remains within normal. - Chronic nephritic syndrome: