Acute kidney injury associated with glomerular diseases

This review focuses on acute kidney injury (AKI) associated with glomerular diseases and specifically the mechanisms of development of AKI in the wide spectrum of glomerulopathies.

The immune system and the kidneys are closely linked. In healthy individuals, the kidneys contribute to immune homeostasis, whereas components of the immune system mediate many acute forms of kidney disease. Both crescentic and noncrescentic forms of acute glomerulonephritis can present as AKI. The diagnosis of glomerular diseases underlying AKI requires a high degree of suspicion coupled with an algorithmic approach to laboratory investigations. Renal biopsy represents the gold standard for the diagnosis of medical conditions of the kidney. The main clinical-biological presentations of glomerular diseases are acute nephritic syndrome, nephrotic syndrome and rapidly progressive glomerulonephritis (RPGN). All these presentations can be worsened by AKI both in the onset and in the clinical course. Heavy proteinuria and macroscopic hematuria can be directly involved in the development of AKI.

AKI associated with glomerular diseases is not uncommon. Sometimes it represents an emergency case. The understanding of the various mechanisms underlying kidney diseases is improving, and may aid in their prevention and treatment.