Acute Glomerulonephritis (AGN) often follows a strep infection and our young man reports fever and sore throat two weeks ago. The onset is usually sudden . His clinical presentation and initial labs show a decrease in urine output and concentrated urine that is reddish-brown along with positive testing for blood and protein in his urine are demonstrating inflammation of the glomerulus.

Inflammation of the glomerulus thickens the glomerular membrane. This thickening decreases the glomerular filtration rate which lead to reabsorption of sodium and water. The additional fluid is resulting in his symptoms of edema and increase in blood pressure. The inflammation changes the membrane permeability allowing blood and protein to cross into the urine. When the hemoglobin has prolonged contact with urine it transforms to methemoglobin. The blood cell crossing into the urine results in the reddish-brown color.

The immune-mediated response with cellular infiltration decreases GFR, which leads to fluid retention. Salt and water are reabsorbed and contributes to fluid volume expansion and hypertension. A urinalysis will show two major changes; hematuria and proteinuria, and a 24 hour urine will exceed 3 to 5g of protein per day. Increased red blood cell cast and protein raises the specific gravity. Next a blood test should be ordered to determine electrolyte values. Increased bun, creatinine, and potassium are indicative of decrease kidney function.

Treatment is focused on treating the primary cause of AGN and managing the associated problems. Hematuria will result in anemia and can be monitored by hemoglobin and hematocrit and the additional monitoring of iron, B12, and ferritin levels. Iron and vitamin B12 can be given to supplement deficiencies. Erythropoietin is a glycoprotein that increases or maintains red cell levels. Erythopoietin stimulates the proliferation of immature erythroid cells. It is given intravenously or subcutaneously as it is broken down by gastric secretions. It is given over time and is not used for acute severe anemia (in which a blood transfusion would be more appropriate). No antibodies to erythropoietin have been detected and it is not affected by dialysis. Hopefully our patient will not need dialysis due speedy diagnosis fine care.

Huether, S., & McCance, K., (2002). Pathophysiology: the biologic basis for disease in adults & children St.Louis: Mosby, Inc