The 4 classical presentations of glomerulonephritis.

This is a notoriously complicated topic. However, a basic appreciation of the major presentations of glomerulonephritis should suffice for final exams.

1-Acute nephritic syndrome

2-Asymptomatic haematuria and / or proteinuria

3-Nephrotic syndrome

4-Chronic renal failure

1/ The acute nephritic syndrome is manifest by haematuria, hypertension, oliguria, proteinuria and sometimes oedema. This is most often seen with either acute proliferative glomerulonephritis (often post streptococcal) or diffuse proliferative crescenteric glomerulonephritis (seen in systemic vasculitis and rarely anti GBM disease).

2/This is typical of IgA nephropathy when recurrent heavy haematuria can occur following URTI. Asymptomatic proteinuria can also be seen with IgA nephropathy or the membranoproliferative glomerulonephritides.

3/ Characterised by heavy proteinuria (>3.5g day), hypoalbuminaemia, oedema and hypercholesterolaemia. This is most commonly associated with minimal change disease in children and membranous glomerulonephritis in adults.

4/  Chronic renal failure from glomerulonephritis may follow from symptomatic acute nephritic syndrome eg due to systemic vasculitis with crescenteric glomerulonephritis or it may follow on from the recurrent haematuria of IgA nephropathy. Chronic renal failure with significant elevations of urea and creatinine may also be diagnosed de novo and be due to the progression of preexisting glomerulonephritis. In some cases a diagnosis cannot be made because the end stage atrophic kidneys preclude diagnosis.

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A child with nephrotic syndrome