eMedicine Specialties > Nephrology > Glomerular Diseases

Glomerulonephritis, Diffuse Proliferative: 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: May 11, 2009

Follow-up

Further Inpatient Care

  • Patients should be monitored closely for steroid-induced diabetes, electrolyte abnormalities, abnormal gas exchange, and opportunistic infections.

Further Outpatient Care

  • Renal function should be monitored closely.
  • Hypertension should be treated aggressively.
  • Patients should be monitored closely for steroid-induced diabetes and opportunistic infections.

Deterrence/Prevention

  • No clear risk factors are associated with development of DPGN; thus, no known preventive methods can be advocated.

Complications

  • End-stage renal disease
  • Complications of steroid or cytotoxic therapy are discussed under Medication. The commonly encountered complications include diabetes, opportunistic infections, and infertility.
  • Complications of the specific diseases are discussed in other articles.

Prognosis

  • Evidence of glomerulosclerosis, fibrous crescents, tubular atrophy, and, particularly, interstitial fibrosis using light microscopy indicates advanced disease and a poor prognosis.
  • Being a male is a higher risk factor for a bad prognosis.1 Other risk factors associated with a bad prognosis include heavy proteinuria, hypertension, interstitial fibrosis, oliguria, and azotemia at presentation.
  • Renal survival is best with IgA and worse with anti-GBM disease. In some series, the rate of progression to ESRD in class IV lupus was 50% during a 2-year follow-up.11
  • Overall, about 50% of patients with DPGN require dialysis within 6-12 months after presentation.

Patient Education

  • Educate patients on the disease process, renal prognosis, complications of therapy, and importance of adhering to the treatment plan. The importance of keeping appointments must be emphasized.
  • For those with advanced renal failure, options for renal replacement therapy (ie, hemodialysis, peritoneal dialysis, transplantation) should be fully discussed.
  • For excellent patient education resources, visit eMedicine's Kidneys and Urinary System Center. Also, see eMedicine's patient education article Blood in the Urine.
  • For further information, see Mayo Clinic - Kidney Transplant.

Miscellaneous

Medicolegal Pitfalls

  • Delay in diagnosis and treatment may result in rapid progression to ESRD.
  • Inadequate monitoring of cytotoxic therapy may result in life threatening complications.

Special Concerns

  • Infertility may result from use of cyclophosphamide; thus, informed consent should be obtained before instituting this form of therapy.
 


More on Glomerulonephritis, Diffuse Proliferative

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

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Further Reading

Clinical guidelines:
ACR Appropriateness Criteria® hematuria. American College of Radiology - Medical Specialty Society. 1995 (revised 2005). 6 pages. NGC:004611

Specific management of IgA nephropathy: role of triple therapy and cytotoxic therapy. Caring for Australasians with Renal Impairment - Disease Specific Society. 2005 Sep. 11 pages. NGC:006136

Clinical trials:
Calcitriol in the Treatment of Immunoglobulin A Nephropathy

Safety Study of AMG 811 in Subjects With Systemic Lupus Erythematosus With and Without Glomerulonephritis

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Keywords

diffuse proliferative glomerulonephritis, lupus, nephritis, glomerular, glomerulonephritis, lupus nephritis, glomerulus, lupus nephritis class IV, DPGN, autoimmune disorders, systemic lupus erythematosus, SLE, connective tissue disease, glomeruli, vasculitis syndromes, Wegener granulomatosis, glomerular basement membrane, microscopic polyangiitis, Churg-Strauss syndrome, essential mixed cryoglobulinemia, membranoproliferative glomerulonephritis, Henoch-Schönlein purpura, connective tissue diseases, rapidly progressive glomerulonephritis, RPGN,anti–glomerular basement membrane disease, anti-GBM disease, antineutrophil cytoplasmic antibody–associated glomerulonephritis, ANCA-associated glomerulonephritis, crescentic glomerulonephritis, Goodpasture syndrome, microscopic polyarteritis nodosa

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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

James H Sondheimer, MD, Director of Hemodialysis Unit, Harper Hospital; Associate Professor, Department of Internal Medicine, Division of Nephrology, Wayne State University School of Medicine
James H Sondheimer, MD is a member of the following medical societies: American College of Physicians and American Society of Nephrology
Disclosure: Nothing to disclose.

Pharmacy Editor

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

Managing Editor

Ajay K Singh, MB, MRCP, MBA, Associate Professor of Medicine, Harvard Medical School; Clinical Chief, Renal Division, Director of Dialysis, Brigham and Women's Hospital; Consulting Staff, Faulkner Hospital
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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