Which finding leads you to suspect acute glomerulonephritis in your 32 y.o. patient?
A. Dysuria, frequency, and urgency
B. Back pain, nausea, and vomiting
C. Hypertension, oliguria, and fatigue
D. Fever, chills, and right upper quadrant pain radiating to the back
Correct Answer: C. Hypertension, oliguria, and fatigue
Mild to moderate HTN may result from sodium or water retention and inappropriate renin release from the kidneys. Oliguria and fatigue also may be seen. Other signs are proteinuria and azotemia. The term “glomerulonephritis” encompasses a subset of renal diseases characterized by immune-mediated damage to the basement membrane, mesangium, or the capillary endothelium, leading to hematuria, proteinuria, and azotemia.
Option A: As the glomerular filtration rate (GFR) is decreased, symptoms like edema and hypertension occur, majorly due to the subsequent salt and water retention caused by the activation of the renin-angiotensin-aldosterone system.
Option B: Acute forms of glomerulonephritis can result from either a primary renal cause or a secondary illness that causes renal manifestations. Most forms of glomerulonephritis are considered progressive disorders, which without timely therapy progress to chronic glomerulonephritis (characterized by progressive glomerular damage and tubulointerstitial fibrosis leading to a reduced glomerular filtration rate).
Option D: Etiological classification can be made on the basis of clinical presentation, which can range from severe proteinuria (>3.5 g/day) and edema qualifying for nephrotic syndrome, to a nephritic syndrome where hematuria and hypertension are more prominent while proteinuria is less pronounced.
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