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Infection-related glomerulonephritis

Key sources
The following summarized guidelines for the evaluation and management of infection-related glomerulonephritis are prepared by our editorial team based on guidelines from the Kidney Disease: Improving Global Outcomes Foundation (KDIGO 2021).
1

Guidelines

1.Classification and risk stratification

Risk factors: recognize the risk features of different etiologies of infection-related glomerulonephritis:
Situation
Guidance
Postinfectious glomerulonephritis
Children, elderly, immunocompromised host, low socioeconomic status
Shunt nephritis
Ventriculoatrial (highest), ventriculojugular (mid), ventriculoperitoneal (least)
Endocarditis-related glomerulonephritis
Prosthetic valve or structural heart valve lesion, substance abuse, elderly, diabetes mellitus, HCV, HIV
Immunocompromised host
IgA-dominant infection-related glomerulonephritis
Diabetes mellitus, hypertension, heart disease, malignancy, alcohol or substance abuse, or kidney transplantation
B
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  • Prognosis

2.Diagnostic investigations

History and physical examination: elicit a history of an antecedent resolved pharyngitis (1-2 weeks) or impetigo (4-6 weeks) in patients with suspected postinfectious glomerulonephritis. Recognize that some patients have active skin or tonsil infections present.
B
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  • Laboratory tests

  • Echocardiography

3.Diagnostic procedures

Kidney biopsy: consider performing kidney biopsy in patients with suspected bacterial infection-related glomerulonephritis, particularly when culture evidence of infection is elusive or the diagnosis is in doubt, to assess prognosis, and/or for potential therapeutic reasons, as well as to establish the correct diagnosis in some circumstances where comorbidities contribute to confounding effects.
C

4.Medical management

General principles: treat edema and hypertension, as well as persistent proteinuria and/or progressive GFR decline as per glomerulonephritis guidelines.
B

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  • Antimicrobial therapy

  • Immunosuppressive therapy

5.Specific circumstances

Patients with viral infection-related glomerulonephritis, hepatitis B virus: test for HBV infection in patients with proteinuric glomerular disease.
B
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  • Patients with viral infection-related glomerulonephritis (HIV)

  • Patients with parasite-related glomerulonephritis (schistosomiasis)

  • Patients with parasite-related glomerulonephritis (filariasis)

  • Patients with parasite-related glomerulonephritis (malaria)

6.Preventative measures

Prevention of epidemic poststreptococcal glomerulonephritis: consider implementing socioeconomic interventions and mass antimicrobial use to improve living conditions and limit the spread of infection to prevent epidemic poststreptococcal glomerulonephritis in populations where group A streptococcus infection and scabies are highly prevalent.
C

7.Follow-up and surveillance

Serial laboratory assessment
Follow kidney function, measure serum C3 and C4 levels, obtain urinalysis, and assess albumin-creatinine ratio and proteinuria at appropriate intervals until complete remission or return to baseline.
B
Consider performing kidney biopsy in postinfectious glomerulonephritis with persistently low C3 beyond 12 weeks, to particularly exclude C3 glomerulonephritis.
C