REVIEW – May 2009

Glomerulonephritis – unnoticeably progressing renal damage


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Glomerulonephritides (GN) are supposedly immunologically mediated glomerular diseases. Often, but not always, they are infl ammatory in nature – exudation of neutrophils and/or macrophages and proliferation of mesangial and/or endothelial cells. According to a simplifi ed classifi cation of primary glomerulonephritides, glomerulonephritis can be nonproliferative or proliferative. Nonproliferative glomerulonephritis is represented by minimal change disease, focal segmental glomerulosclerosis and membranous nephropathy. Proliferative glomerulonephrites are IgA nephropathy and membranoproliferative glomerulonephritis.
The syndrome of glomerulonephritis is characterized by haematuria, proteinuria, hypertension and renal insufficiency. Urinary  findings are important, but renal biopsy remains essential for diagnosis, treatment and assesment of outcome. Patients suffering from primary glomerulonephritis are endangered by complications of nephrotic syndrome and progression to end stage renal failure. Primary GN are treatable diseases and patients should be treated according to available evidence. Treatment of the GN includes drugs and procedures with relatively well defined indications like corticosteroids, cytotoxics, cyclosporine and symptomatic treatment with ACEI, AIIA, and other antihypertensives. Further progress in treatment depends on a better understanding of the pathogenesis of the disease. Patients with glomerulonephritis need active follow-up and, if necessary, treatment.