Rapidly progressive glomerulonephritis (RPGN) is a rapid deterioration in kidney function over a short time. This condition usually occurs when there is an acute inflammation of the kidneys.
RPGN is linked to an immune reaction against the glomerulus, the filtering unit of the kidney. Antibodies that form against an infection can become trapped in the glomeruli. The resulting inflammation causes protein and blood to be excreted in the urine. The ability of the kidneys to get rid of toxic wastes is impaired.
The causes of RPGN include:
Symptoms of RPGN include:
Uremia may cause:
Diagnosis of RPGN starts with a medical history and a complete physical exam. Urine tests will also be done. High levels of protein and red blood cells in the urine indicate RPGN. The diagnosis is confirmed by a kidney biopsy. The biopsy is very useful, because it can show the type and severity of disease. Other laboratory tests and blood cultures may also be done.
Depending on the cause, some cases of RPGN may be prevented. Early treatment of other conditions, such as systemic lupus erythmatosus or hepatitis, may help prevent RPGN from these causes. In other cases, RPGN cannot be prevented.
Long-term effects of RPGN vary, depending on the underlying cause. For example, hepatitis may cause long-term effects in the liver and kidneys. An infection that is treated promptly may cure the cause of the RPGN, and there may be no long-term effects. The longer the condition goes untreated, the more devastating it can be. If it is not treated, the kidneys and renal system can be permanently damaged. End-stage renal disease, the permanent and complete loss of kidney function, can occur within days or weeks of the start of RPGN.
RPGN is not contagious by itself, but the underlying cause may be contagious. For example, if cause of the RPGN is hepatitis, the hepatitis can be spread to others.
Treatment of RPGN depends on the underlying cause. Corticosteroids or other medications that suppress the immune system may be used. Plasmapharesis, or blood filtering, may be done. The person may need bed rest and restricted fluid and salt intake, to give the kidneys a chance to heal. Treatment for the underlying cause, such as antibiotics for a strep infection, may also be needed.
Corticosteroids can cause fluid retention, swelling, weight gain, and increased risk of infection. Taking corticosteroids for a long time can cause osteoporosis, or bone thinning. Some of the more aggressive medication treatments may increase the risk of infections and cancer.
Early treatment of RPGN is essential to avoid kidney damage. Severe RPGN can result in end-stage renal disease.
Close follow-up with the healthcare provider is needed. Regular blood tests can help monitor for recurrences of RPGN. Kidney function should also be monitored regularly. Any new or worsening symptoms should be reported to the healthcare provider.
Author:Crystal R. Martin, MD
Editor:Duff, Ellen, BA
Reviewer:Eileen McLaughlin, RN, BSN