Chronic Glomerulonephritis Clinical Presentation

Updated: Feb 01, 2017
  • Author: Moro O Salifu, MD, MPH, FACP; Chief Editor: Vecihi Batuman, MD, FASN  more...
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Presentation

History

The history should begin by focusing on cause-specific symptoms to determine the source of the chronic kidney disease (CKD) if this is unknown. Recognition of such symptoms facilitates the planning of further workup and management of the disease (if systemic).

The next step is to look for symptoms related to uremia to determine if renal replacement therapy is needed. The following symptoms suggest uremia:

  • Weakness and fatigue
  • Loss of energy, appetite, and weight
  • Pruritus
  • Early morning nausea and vomiting
  • Change in taste sensation
  • Reversal in sleep pattern (ie, sleepiness in daytime and wakefulness at night)
  • Peripheral neuropathy
  • Seizures
  • Tremors

The presence of edema and hypertension suggests volume retention. Dyspnea or chest pain that varies with position suggests fluid overload and pericarditis, respectively. Leg cramps may suggest hypocalcemia or other electrolyte abnormalities. Weakness, lethargy, and fatigue may be due to anemia.

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Physical Examination

Cause-specific physical examination findings are discussed elsewhere, in articles describing the specific causes (see Etiology). Uremia-specific physical findings include the following:

  • Hypertension
  • Jugular venous distention (if severe volume overload is present)
  • Pulmonary rales (if pulmonary edema is present)
  • Pericardial friction rub in pericarditis
  • Tenderness in the epigastric region or blood in the stool (possible indicators of uremic gastritis or enteropathy)
  • Decreased sensation and asterixis (indicators of advanced uremia)
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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
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