What are the clinical manifestations of acute glomerulonephritis?

Acute glomerulonephritis has a very serious impact on patients. When they are harmed by this disease, they often show symptoms of hematuria, proteinuria or edema. Some patients also have high blood pressure and some abnormal renal function symptoms.

1. Hematuria and proteinuria

Almost all patients have glomerular hematuria, and about 30% of patients may have macroscopic hematuria, which is often the first symptom of the disease and the reason for patients to seek medical treatment. It may be accompanied by mild to moderate proteinuria, and about 20% of patients present with proteinuria in the nephrotic syndrome range. In addition to red blood cells, urine sediment may also show an increase in white blood cells and epithelial cells in the early stages, as well as granular casts and red blood cell casts.

2. Edema

Edema is often the initial symptom of the disease, typically manifested as eyelid edema in the morning or accompanied by mild pitting edema of the lower limbs. In a few severe cases, it can affect the whole body.

3. Hypertension

Most patients experience transient mild to moderate hypertension, which is often related to sodium and water retention. Blood pressure can gradually return to normal after diuresis. A small number of patients may develop severe hypertension or even hypertensive encephalopathy.

4. Abnormal renal function

In the early stages of the disease, patients may experience decreased urine volume due to decreased glomerular filtration rate and sodium and water retention. A few patients may even experience oliguria (<400 ml/d). Renal function may be transiently impaired, manifesting as mild azotemia. After more than 1 to 2 weeks, the urine volume gradually increases, and renal function can gradually return to normal within a few days after diuresis. Only a very small number of patients may present with acute renal failure, which needs to be differentiated from rapidly progressive nephritis.

5. Congestive heart failure

It often occurs in the acute phase, with severe water and sodium retention and hypertension as important causes, and requires emergency treatment.

6. Abnormal immunological examination

Transient decrease in serum complement C3: It usually decreases 2 weeks after onset and gradually returns to normal within 8 weeks, which is of great significance for the diagnosis of this disease. The patient's serum antistreptolysin "O" titer may be elevated.