Fortnightly Review: Glomerulonephritis: diagnosis and treatment

There is a spectrum of disease, from such asymptomatic urinary abnormalities to the nephritic and nephrotic syndromes and indeed some patients have features of both. The nephritic syndrome is the abrupt onset of haematuria (often with red blood cell casts), proteinuria (usually moderate), reduced renal function, and salt and water retention causing oedema and hypertension. The nephrotic syndrome is heavy proteinuria (> 3.5 g/24 h) associated with hypoproteinaemia, distinct oedema, and often hypercholesterolaemia. Although the history, examination, urine analysis, and blood investigations (box 2) may suggest a likely cause, definitive diagnosis requires a renal biopsy. Underlying glomerulonephritis is also considered to be the cause of end stage renal failure in about a quarter of patients accepted on to dialysis programmes. As the progression of glomerulonephritis may be insidious some patients present in chronic renal failure with small smooth kidneys. By this time renal biopsy is more hazardous and less …