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inflammatory bowel disease, carcinomas, variolls infections, and

rheumatic disorders have been highly associated with the development of [gA nephropathy.9.18.22.23

Signs and symptoms of IgA nephropathy include the

following9.18.22.2J:

•

Hematuria

• Proteinuria

• Oliguria

Management of IgA nephropathy includes the administration of

any of the following9.18.n

GENITOURINARY $Y$TE.."l.

575

• Anti-inflammatory agents, such as ora) glucocorricoids (prednisone)

• Angiotensin converting enzyme (ACE) inhibirors

• Cytotoxic agents

• Fish oils (effectiveness is controversial)23.24

Postinfectious C lomeTII IOlleph ritis

As the name states, postin(ectiolls glomerulonephritis is acute inflammation in the renal system that occurs after infection. Group (X.- and

�-hemolytic streprococci are the common causative pathogens that

lead ro the damage of surface proteins in the glomeruli.9,ls,',.25 Other

organisms that have been associated with this form of acute glomerulonephritis include hepatitis B virus, hepatitis C virus, and human immunodeficiency virllS; spirochetes, slich as Treponema pallidum;

protozoa, such as Plasmodium Inalariae; and fungi, such as Candida

albicalls." Prognosis is generally good once the causative agent is

identified and appropriate anti-infective and supportive therapies are

provided.2'.,s

Signs and symptoms of poststreprococcal glomerulonephritis

include the foliowing'·18.25;

• Acute onset of fluid retemion, hypertension, and peripheral

edema

• Oliguria

• Hematuria

• Mild to moderate proteinuria

• Anemia

• Cola-colored urine with red blood cell casts

Management of poststreprococcal glomerulonephritis includes any

of the following9.18.25;

• Antibiotics

• Antihypertensive agents

• Diuretics

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AClTTE CARE HANDBOOK FOR PHYSICAl THERAPISTS

• Fluid and electrolyte suppOrt (as needed)

• Hemodialysis (as needed)

Rapidly Progressive Clomemlollephrilis

Rapidly progressive glomerulonephritis (RPGN) is also known as

subacute, crescentic, or extracapillary glomerulonephritis. It involves

glomerular inflammation that progresses to renal failure in a few days

or weeks." This disease primarily affects adults who are in their fifties

and sixties and has a relatively poor prognosis. Early detection is critical to effective therapy and patient survivaI.2'.,. Causes of RPGN can include acute or subacute infection from �-hemolytic streptococci or

from other bacteria, viruses, or parasites. It can also be caused by

multisystem or autoimmune disease.9,18,25

Signs and symptoms of RPGN include the following"IS.,,:

• Rapid, progressive reduction in tenal function

• Severe oliguria

• Anuria, with irreversible renal failure

Management of RPGN includes any of the following'·18.26:

•

Anti-inflammatory agents (e.g., prednisone)

• Plasma pheresis

• Anticoagulation treatment

• Hemodialysis

• Renal transplantation

Chrollic G/omemlollephritis

Chronic glomerulonephritis is the culmination of diseases that can

affect the glomeruli leading to progressive renal failure in 10-20

years. These diseases include those mentioned in the previous section,

along with diabetes, hepatitis, and systemic lupus erythematosus.2'

Chronic glomerulonephritis involves scarring and obliteration of the

glomeruli, along with vascular sclerosis of arteries and arterioles.9,ls

Signs and symptoms of chronic glomerulonephritis include the

following',18:

GENn·OURJNARY SYSTEM

577

• Uremia

• Proteinuria

• Hypertension

• Azotemia

Management of chronic glomerulonephritis includes any of the

following9•18;

• Treatment of primary disease or dysfunction

• Administration of steroidal anti-inflammatory agents

• Administration of anti-infective or cytotoxic agents, or both

• Dialysis

•

Renal transplantation

Other types of glomerulonephritis are minimal change disease

(lipoid nephrosis), focal segmental glomerulonephritis membranous

nephropathy, and membranoproliferative glomerulonephritis (slowly

progressive glomerulonephritis).7 These are not discussed in this

chapter, because they have similar clinical manifestations as the types

of glomerulonephritis discussed previously.

Nephrotic Syndrome

Nephrotic syndrome is a group of symptoms characterized by an

increased permeability of the glomerular basement membrane that

results in excessive excretion of protein molecules, which ultimately

leads to reduced osmotic pressures that can result in peripheral

edema. J\!lany conditions can lead to nephrotic syndrome, including

the followings.9•16;

• Acute glomerulonephritis (lgA nephropathy)

• Diabetes mellitus

• Amyloidosis

• Infections (human immunodeficiency virus, hepatitides B and C)

• Circulatory diseases

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AClITE CARE HANDBOOK FOR PHYSICAL THERAPISTS

• Allergen or drug reactions (nonsteroidal anti-inflammatory

agents, penicillin, captopril, heroin)

o

Pregnancy (pre-eclampsia)

o

Chronic allograft rejection after renal transplantation

Physical findings of nephrotic syndrome include the following8.9.26:

• Hypoalbuminemia

o

Generalized edema

o

Hyperlipidemia

o

Lipiduria (lipid casts or free fat droplets in urine)

o

Vitamin 0 deficiency

Management of nephrotic syndrome includes any of the

following8.9.28.29:

o

Treatment of underlying disease

• Administration of steroidal anti-inflammatory agents

o

Albumin replacement

• Diuretics

o

Anticoagulation therapy

•

Dietary modifications (e.g., normal protein, low fat, salt restrictions)

Interstitial Nephritis

Infection, urinary tract obstruction, and reactions to medications,

particularly nonsteroidal ami-inflammatory agents, can result in

inflammatory, intcrstirial tissue damage, which is referrcd to as interstitial nephritis.8.l0.ll Scarring from the inflammatory process leads to reduced kidney function that can progress to CRE Early detection is

helpful in treating the inflammatory response.'

Physical findings of interstitial nephritis include the following':

o

Polyuria

• Nocturia