eMedicine Specialties > Nephrology > Glomerular Diseases

Glomerulonephritis, Chronic: Follow-up

Author: Moro O Salifu, MD, MPH, FACP, Associate Professor, Department of Internal Medicine, Chief, Division of Nephrology, Director of Nephrology Fellowship Program and Transplant Nephrology, State University of New York Downstate Medical Center
Coauthor(s): Barbara G Delano, MD, MPH, Director of Home Hemodialysis and Peritoneal Dialysis, Professor, Department of Internal Medicine, Division of Nephrology, State University of New York at Brooklyn
Contributor Information and Disclosures

Updated: Oct 23, 2009

Follow-up

Further Inpatient Care

Patients with CKD admitted to the hospital should have careful monitoring of weight, intake, output, and renal function so that acute renal failure, if it occurs, can be diagnosed and treated early. All potentially nephrotoxic agents must be adjusted for the degree of CKD. Furthermore, agents, such as nonsteroidal anti-inflammatory drugs (NSAIDs), aminoglycosides, and intravenous contrast, must be avoided, unless the benefits clearly outweigh the risks, because these agents are highly associated with acute renal failure.

Further Outpatient Care

Patients with any evidence of kidney disease should be referred to a kidney specialist (nephrologist). Data suggest that early referral to a nephrologist improves the overall outcome. The nephrologist will usually determine the frequency of visits based on the degree of CKD.

Complications

  • The presence of the following complications generally indicates a need for urgent dialysis:
    • Metabolic acidosis
    • Pulmonary edema
    • Pericarditis
    • Uremic encephalopathy
    • Uremic gastrointestinal bleeding
    • Uremic neuropathy
    • Severe anemia and hypocalcemia
    • Hyperkalemia

Prognosis

The prognosis depends on the type of chronic glomerulonephritis (see Causes).

Patient Education

  • For further information, see Mayo Clinic - Kidney Transplant Information.
  • Dietary education is paramount in managing patients with CKD. The typical dietary restriction is 2 g of sodium, 2 g of potassium, and 40-60 g of protein a day. Additional restrictions may apply for diabetes, hyperlipidemia, and fluid overload.
  • Patients should be educated regarding the types of ESRD therapy. The specific choices of ESRD therapy include hemodialysis, peritoneal dialysis, and renal transplantation.

    • Patients opting for hemodialysis should be educated on home hemodialysis (ie, patients are trained to do their dialysis at home) and center hemodialysis (ie, patients must come to a center 3 times a week for 3.5- to 4-hour dialysis sessions). They should also be educated on the types of vascular access. Arteriovenous fistulae should be created when the GFR falls below 25 mL/min or the serum creatinine level is greater than 4 mg/dL to allow for maturation of the access prior to the initiation of dialysis.
    • Peritoneal dialysis catheters can be placed if dialysis is anticipated within 2-3 weeks.
    • Preemptive transplantation before the initiation of dialysis improves survival as compared with transplantation after the initiation of dialysis; therefore, preemptive transplantation should be explored from live donors. In patients without live donors, they can be placed on the deceased donor wait list when the GFR falls below 20 mL/min to accrue time. Patients who opt for no treatment when it is indicated should be informed of imminent renal failure in a shorter time.
  • In the United States and most developed countries, patients on dialysis can travel. In fact, there are even dialysis cruises. However, patients should inform their social workers to make the necessary arrangements prior to any travel to ensure that the destination has the right resources to continue dialysis.
  • Sexual dysfunction and loss of libido is common in patients with kidney disease, especially in men. Patients should be told to seek medical therapy if they experience these symptoms.

Miscellaneous

Medicolegal Pitfalls

  • Nephrotic (urinary protein excretion, >3.5 g/d) patients may have hyperlipidemia. As a part of cardiovascular health care, lipid profile should be checked and lipid-lowering therapy started for patients with hyperlipidemia.
  • Steroid therapy may induce or exacerbate diabetes, hypertension, weight gain, fat redistribution in the trunk (buffalo hump) and face (moon facies), cosmetic problems (eg, hirsutism, acne), and osteoporosis.

    • Monitor fasting blood glucose levels and blood pressure. Obtain baseline bone densitometry values. Repeat bone densitometry for bone pain.
    • Oral calcium supplements (1 g/d) and vitamin D (400-800 IU/d) are recommended for prophylaxis against osteoporosis.

Special Concerns

  • Renal failure and hypertension worsen during pregnancy in patients with CKD, particularly when the serum creatinine level exceeds 2 mg/dL. The result is decreased fetal viability and increased maternal morbidity in pregnant women with CKD. Therefore, women with CKD should consult their doctors prior to pregnancy.
 


More on Glomerulonephritis, Chronic

Overview: Glomerulonephritis, Chronic
Differential Diagnoses & Workup: Glomerulonephritis, Chronic
Treatment & Medication: Glomerulonephritis, Chronic
Follow-up: Glomerulonephritis, Chronic
References
Further Reading
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References

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Further Reading

Clinical guidelines:
ACR Appropriateness Criteria® renal failure. American College of Radiology - Medical Specialty Society. 1995 (revised 2008). 10 pages. NGC:007019

Clinical trials:
 Efficacy and Safety Study of Abatacept to Treat Lupus Nephritis

Etanercept for the Treatment of Lupus Nephritis

Retinoids for Minimal Change Disease and Focal Segmental Glomerulosclerosis

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Keywords

glomerulonephritis, chronic glomerulonephritis, IgA nephropathy, membranous nephropathy, membranoproliferative glomerulonephritis, poststreptococcal glomerulonephritis, glomerulonephritis treatment, crescentic glomerulonephritis, glomerulosclerosis, rapidly progressive glomerulonephritis, RPGN, focal segmental glomerulosclerosis, FSGS, glomerular fibrosis, tubulointerstitial fibrosis, lupus nephritis, azotemia, uremia

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Contributor Information and Disclosures

Author

Moro O Salifu, MD, MPH, FACP, Associate Professor, Department of Internal Medicine, Chief, Division of Nephrology, Director of Nephrology Fellowship Program and Transplant Nephrology, State University of New York Downstate Medical Center
Moro O Salifu, MD, MPH, FACP is a member of the following medical societies: American College of Physicians-American Society of Internal Medicine, American Medical Association, American Society for Artificial Internal Organs, American Society of Diagnostic and Interventional Nephrology, American Society of Nephrology, American Society of Transplantation, and National Kidney Foundation
Disclosure: Nothing to disclose.

Coauthor(s)

Barbara G Delano, MD, MPH, Director of Home Hemodialysis and Peritoneal Dialysis, Professor, Department of Internal Medicine, Division of Nephrology, State University of New York at Brooklyn
Barbara G Delano, MD, MPH is a member of the following medical societies: American Society of Nephrology, International Society of Nephrology, National Kidney Foundation, and Sigma Xi
Disclosure: Nothing to disclose.

Medical Editor

Frank C Brosius III, MD, Nephrology Program Director, Professor of Internal Medicine and Physiology, Department of Internal Medicine, Division of Nephrology, University of Michigan School of Medicine
Frank C Brosius III, MD is a member of the following medical societies: Alpha Omega Alpha, American Diabetes Association, American Society of Nephrology, and Phi Beta Kappa
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: eMedicine Salary Employment

Managing Editor

George R Aronoff, MD, Director, Professor, Departments of Internal Medicine and Pharmacology, Section of Nephrology, Kidney Disease Program, University of Louisville School of Medicine
George R Aronoff, MD is a member of the following medical societies: American Federation for Medical Research, American Society of Nephrology, Kentucky Medical Association, and National Kidney Foundation
Disclosure: Nothing to disclose.

CME Editor

Rebecca J Schmidt, DO, FACP, FASN, Professor of Medicine, Section Chief, Department of Medicine, Section of Nephrology, West Virginia University School of Medicine
Rebecca J Schmidt, DO, FACP, FASN is a member of the following medical societies: American College of Osteopathic Internists, American College of Physicians, American Medical Association, American Society of Nephrology, International Society of Nephrology, National Kidney Foundation, Renal Physicians Association, and West Virginia State Medical Association
Disclosure: Abbott Grant/research funds Speaking and teaching; Genzyme Honoraria Consulting; Amgen Honoraria Speaking and teaching; Ortho Biotech Honoraria Speaking and teaching

Chief Editor

Vecihi Batuman, MD, FACP, FASN, Professor of Medicine, Section of Nephrology-Hypertension, Tulane University School of Medicine; Chief, Medicine Service, Southeast Louisiana Veterans Health Care System
Vecihi Batuman, MD, FACP, FASN is a member of the following medical societies: American College of Physicians, American Society of Hypertension, American Society of Nephrology, and International Society of Nephrology
Disclosure: Nothing to disclose.

 
 
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