Primary acute glomerulonephritis is the first occurrence of immune injury in the kidneys, characterized by sudden onset of hematuria, proteinuria, edema, hypertension, and/or oliguria and azotemia as the main manifestations, also known as acute nephritic syndrome. The disease has various causes, with post-streptococcal infection being the most common.

bubble_chart Diagnosis

1. History and Symptoms

Most patients have a history of upper respiratory or skin infection 1-3 weeks before onset, with sudden appearance of hematuria or edema. Mild cases present with eyelid edema in the morning, while severe cases involve generalized edema accompanied by reduced urine output and weight gain. Some patients may experience dizziness, blurred vision, decreased appetite, fatigue, nausea, vomiting, and dull pain in the lumbar region. Attention should be paid to the presence of high fever or urinary tract irritation symptoms at onset, as well as any history of rash, joint pain, hematuria, or edema.

2. Physical Examination Findings

Mild cases show eyelid edema or grade I edema of the lower limbs, while severe cases may present with pleural effusion, ascites, or generalized edema. Most patients have mild to grade II hypertension.

3. Auxiliary Examinations

Proteinuria varies in severity (1-3g/d), and microscopic hematuria is always present, with red blood cells showing polymorphism and diversity. Red blood cell casts, granular casts, and renal tubular epithelial cells may sometimes be observed. Urinary fibrin degradation products (FDP) may be positive. Blood urea nitrogen and creatinine may transiently increase, while serum total complement (CH50) and C3 levels decrease, usually returning to normal within 8 weeks. Serum anti-streptolysin "O" titers may be elevated.

It should be differentiated from acute febrile proteinuria, rapidly progressive glomerulonephritis, lupus nephritis, Henoch-Schönlein purpura nephritis, chronic glomerulonephritis (acute exacerbation type), and acute allergic interstitial nephritis, among other conditions.

bubble_chart Treatment Measures

I. General Treatment

(1) Bed rest should be maintained after onset until gross hematuria disappears, edema subsides, and blood pressure returns to normal. Afterward, strenuous activities and common cold should still be avoided, with a general rest period of at least six months.

(2) A high-sugar, vitamin-rich, low-salt diet should be provided. <3g/d）飲食，出現氮質血症者應限制蛋白質攝入量。

(3) For those with significantly reduced urine output, fluid and potassium intake should be restricted.

II. Drug Therapy

(1) Diuresis: If edema remains significant after limiting water and salt intake, diuretics such as furosemide 20mg three times daily or hydrochlorothiazide 25mg three times daily may be used. For severe oliguria, intravenous furosemide 200–400mg/day may be administered. Osmotic diuretics and potassium-sparing diuretics are generally not recommended.

(2) Antihypertensive Therapy: If blood pressure remains high after diuretic treatment, antihypertensive drugs such as nifedipine 10mg three times daily or captopril 25mg three times daily (used with caution in severe oliguria) should be added. Severe hypertension may require intravenous sodium nitroprusside.

(3) Anti-infective Therapy: For those with infection sites or accompanying fever, antibiotic treatment such as penicillin 800,000 units intramuscularly twice daily for two weeks is necessary. For recurrent chronic tonsillitis, tonsillectomy may be performed when urinary protein is less than (+) and urinary red blood cells are fewer than 10/HP.

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(5) For persistent hematuria, high-dose vitamin C and oral Root Leaf or Flower of Common Threewingnut glycosides may be used. For significant hematuria, add Chinese medicinals for clearing heat and draining dampness, reducing inflammation, and promoting bowel movements, such as Spleen-Qi Effusing Decoction or Eight-Ingredient Rectification Powder. Based on pattern identification, treatments like Six-Ingredient Rehmannia Pill, Cassia Bark, Aconite and Rehmannia Pill, or Anemarrhena, Phelloendron and Rehmannia Pill may be applied.

III. Blood Purification Therapy

For those with concurrent acute renal failure, prompt hemodialysis or peritoneal dialysis should be performed (refer to the Blood Purification section).