Acute Glomerulonephritis & RPGN
Rapidly progressive glomerulonephritis can destroy kidney function within days to weeks. Our nephrology team provides urgent dialysis support and plasmapheresis for autoimmune kidney emergencies including Goodpasture syndrome, lupus nephritis, and ANCA vasculitis.
Understanding Rapidly Progressive Glomerulonephritis
RPGN is a clinical syndrome of rapid kidney function decline over days to weeks, characterized by crescent formation on kidney biopsy. Without aggressive treatment, it progresses to irreversible end-stage kidney disease.
Major causes requiring urgent intervention:
- Anti-GBM disease (Goodpasture's): Antibodies attack the glomerular basement membrane; may also affect lungs causing hemorrhage
- ANCA vasculitis: Granulomatosis with polyangiitis (GPA), microscopic polyangiitis (MPA), causing small vessel inflammation
- Lupus nephritis: Class III/IV proliferative lupus nephritis presenting as nephritic syndrome
- IgA nephropathy: Crescentic IgA nephropathy with rapidly declining function
Clinical Presentation Requiring Urgent Nephrology
Hours matter in RPGN. Each day of delay allows more crescents to form. Urgent biopsy and treatment initiation are critical for kidney survival.
Our Approach to Autoimmune Kidney Emergencies
Comprehensive management combining dialysis support with disease-modifying therapies
Rapid Assessment & Biopsy Coordination
Expedited nephrology consultation with same-day biopsy coordination when indicated. Early histologic diagnosis guides treatment intensity.
Plasmapheresis Services
On-site plasmapheresis for anti-GBM disease and severe ANCA vasculitis. Removes pathogenic antibodies while immunosuppression takes effect.
Dialysis Support During Treatment
Dialysis bridge while awaiting kidney recovery from immunosuppressive therapy. CRRT for hemodynamically unstable patients with pulmonary hemorrhage.
Immunosuppression Coordination
Collaborative management with rheumatology and immunology. Pulse steroids, cyclophosphamide, rituximab dosing coordinated with renal replacement.
Pulmonary-Renal Syndrome Care
Integrated care for patients with both lung and kidney involvement. ICU coordination for patients with diffuse alveolar hemorrhage.
Recovery Monitoring
Serial assessment for kidney recovery. Transition from dialysis as function improves. Long-term follow-up for relapse prevention.
For Hospitalists, Rheumatologists & Internists
When you suspect RPGN or autoimmune kidney disease, rapid nephrology involvement is critical. We provide same-day consultation, expedited biopsy coordination, and immediate plasmapheresis capability when indicated.
- 24/7 nephrology attending for urgent autoimmune cases
- Same-day kidney biopsy coordination when clinically indicated
- On-site plasmapheresis—no transfer to tertiary center required
- Experience with anti-GBM, ANCA vasculitis, lupus nephritis, cryoglobulinemia
- Coordination with rheumatology for dual management
- Long-term follow-up for dialysis-dependent patients awaiting recovery
Disease-Specific Protocols
Anti-GBM Disease
Daily plasmapheresis x14 days + cyclophosphamide + high-dose steroids per KDIGO guidelines
ANCA Vasculitis
Rituximab or cyclophosphamide induction with plasmapheresis for severe cases or DAH
Lupus Nephritis Class IV
Mycophenolate or cyclophosphamide with steroids; dialysis support for severe presentations
Frequently Asked Questions
When is plasmapheresis indicated for glomerulonephritis?
Plasmapheresis is strongly indicated for anti-GBM disease regardless of kidney function, as it removes pathogenic antibodies. For ANCA vasculitis, it's used for severe cases with creatinine >5.7 mg/dL or diffuse alveolar hemorrhage. For other causes, the evidence is less clear, and we assess case-by-case.
Can kidneys recover after RPGN if already on dialysis?
Yes, recovery is possible especially if treated early before extensive crescent formation. Patients with <50% crescents on biopsy have better recovery rates. We maintain dialysis support while immunosuppression takes effect, monitoring for signs of kidney recovery over weeks to months.
How urgent is biopsy for suspected RPGN?
Very urgent. Biopsy should ideally be done within 24-48 hours of presentation. Histologic findings (percentage of crescents, chronicity index) guide treatment intensity and provide prognostic information. We coordinate urgent biopsies with interventional radiology or nephrology proceduralists.
What if the patient has pulmonary hemorrhage?
Pulmonary-renal syndrome is a medical emergency. We provide ICU-level care with ventilator support as needed, urgent plasmapheresis for antibody removal, and CRRT for patients too unstable for intermittent hemodialysis. Simultaneous treatment of lung and kidney disease is coordinated with pulmonology and critical care.
Do you manage long-term immunosuppression?
We collaborate with rheumatology for long-term management. Our role includes initiating urgent treatment, managing dialysis during acute illness, monitoring for recovery, and transitioning stable patients to outpatient nephrology and rheumatology follow-up.
Suspect Rapidly Progressive Glomerulonephritis?
Time is kidney function. If you have a patient with rapidly rising creatinine, active sediment, or suspected autoimmune kidney disease, contact us immediately for urgent nephrology consultation.