GPs should be vigilant for glomerulonephritis

Glomerulonephritis is a histological diagnosis made on renal biopsy, and is defined as inflammation of the glomeruli. It is the second most common renal disease leading to endstage renal disease in the UK. Glomerulonephritis may present in a variety of ways because of the wide range of different diseases that cause inflammation of the glomeruli. Presentation can range from incidental detection of asymptomatic abnormalities in chronic indolent disease to the acutely unwell patient with rapidly progressive glomerulonephritis. Many forms of acute glomerulonephritis respond well to treatment if treated early, but result in serious irreversible loss of renal function if this early treatment opportunity is not recognised. A number of key steps will help identify rapidly progressive glomerulonephritis: recognising that the clinical pattern is compatible with this condition; comparing current information (both urinalysis and serum creatinine/eGFR) with historical results; and additional testing to confirm, quantify and identify the pattern of abnormal results. Chronic glomerulonephritis may first present as CKD of any stage. Patients with chronic glomerulonephritis typically have haematuria, proteinuria and hypertension, and if the disease is advanced small kidneys may be detected by renal ultrasound. The goals of treating both the underlying glomerulonephritis and the consequent chronic kidney disease are to retard progression of the disease, prevent complications and prepare patients for renal replacement therapy in a timely and appropriate manner. With an average 10-year survival of 63%, most practices are likely to have a small number of patients with chronic glomerulonephritis at any one time.