Acute Glomerulonephritis: Understanding Severe Complications and Their Management

Although the incidence of acute glomerulonephritis has been steadily declining in recent years—largely due to the widespread use of antibiotics—the condition still poses significant health risks, especially when severe complications arise. Early recognition and proper management of these complications are crucial for improving patient outcomes and preventing long-term damage.

Common Severe Complications of Acute Glomerulonephritis

While many cases of acute glomerulonephritis resolve on their own or with minimal treatment, a subset of patients may develop life-threatening complications. These complications primarily stem from the kidneys' sudden inability to filter waste and regulate fluid balance effectively. The most serious ones include hypertension, heart failure, and acute kidney injury.

Hypertensive Encephalopathy Due to Severe Hypertension

Elevated blood pressure is one of the hallmark signs of acute glomerulonephritis. When blood pressure rises sharply, it can lead to a dangerous condition known as hypertensive encephalopathy. This occurs when excessive pressure damages the blood-brain barrier, causing cerebral edema and neurological symptoms.

In children, this complication may manifest as seizures or epileptic-like episodes, often alarming both parents and clinicians. Prompt antihypertensive therapy is essential to prevent permanent brain injury or stroke. Monitoring blood pressure closely during the acute phase of illness is therefore critical, particularly in pediatric patients.

Heart Failure: A Consequence of Fluid Overload

Another serious complication is congestive heart failure, which develops secondary to fluid retention and increased circulatory volume. As the kidneys fail to excrete excess sodium and water, fluid accumulates in the lungs and peripheral tissues.

Patients may experience shortness of breath, orthopnea (difficulty breathing while lying flat), and fatigue. In severe cases, pulmonary edema may occur, requiring immediate medical intervention such as diuretic therapy and oxygen support. Managing fluid balance early can significantly reduce the risk of cardiac strain and improve recovery time.

Acute Kidney Injury and the Role of Dialysis

Acute kidney injury (AKI) is a potentially fatal complication of acute glomerulonephritis. It typically presents as oliguria (greatly reduced urine output), leading to worsening edema, hyperkalemia, metabolic acidosis, and uremia.

When kidney function deteriorates rapidly, temporary dialysis may be necessary. This procedure helps remove excess fluids, toxins, and electrolytes from the bloodstream, restoring internal homeostasis. Dialysis acts as a bridge, supporting the body while the kidneys heal, and increases the chances of full renal recovery.

In most cases, kidney function gradually returns over several weeks, especially with timely supportive care. However, close monitoring in a hospital setting is often required to manage complications and prevent progression to chronic kidney disease.

Conclusion: Early Detection Saves Lives

Despite its declining prevalence, acute glomerulonephritis remains a condition that demands vigilance. Recognizing the warning signs of severe complications—such as persistent high blood pressure, breathing difficulties, or decreased urination—can make a critical difference in patient survival and recovery.

With prompt diagnosis, appropriate medical interventions, and supportive therapies like dialysis when needed, most patients can recover fully. Public awareness and access to healthcare continue to play vital roles in reducing morbidity associated with this condition.