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Infection-related glomerulonephritis

Guidelines

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)....
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Classification and risk stratification

Risk factors: as per KDIGO 2021 guidelines, 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
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  • Prognosis

Diagnostic investigations

History and physical examination: as per KDIGO 2021 guidelines, 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.
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  • Laboratory tests

  • Echocardiography

Diagnostic procedures

Kidney biopsy: as per KDIGO 2021 guidelines, 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.
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Medical management

General principles: as per KDIGO 2021 guidelines, Treat edema and hypertension, as well as persistent proteinuria and/or progressive GFR decline as per glomerulonephritis guidelines.
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  • Antimicrobial therapy

  • Immunosuppressive therapy

Specific circumstances

Patients with viral infection-related glomerulonephritis, HBV: as per KDIGO 2021 guidelines, Test for HBV infection in patients with proteinuric glomerular disease.
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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)

Preventative measures

Prevention of epidemic poststreptococcal glomerulonephritis: as per KDIGO 2021 guidelines, 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.
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Follow-up and surveillance

Serial laboratory assessment
As per KDIGO 2021 guidelines:
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.
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Consider performing kidney biopsy in postinfectious glomerulonephritis with persistently low C3 beyond 12 weeks, to particularly exclude C3 glomerulonephritis.
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