Otitis media with effusion

Disease Description (Causes and Symptoms)

• Definition summary: Glomerulonephritis is a group of diseases in which inflammation develops in the glomeruli, the filtration units of the kidneys, causing hematuria, proteinuria, edema, kidney dysfunction, and other problems. It is classified into acute, chronic, nephrotic syndrome, and other forms according to its cause and pathophysiology.
• Major causes: Immunological mechanisms are the most common (autoimmunity, immune-complex deposition, etc.). Other causes include infections (e.g., post-streptococcal glomerulonephritis), metabolic diseases (diabetic nephropathy), drugs and toxins, and genetic causes.
• Pathophysiology (brief): Immune responses or immune-complex and complement activation damage the glomerular filtration barrier (endothelial cells, basement membrane, and podocytes), increasing permeability (proteinuria), or causing hematuria and decreased kidney function due to glomerular fibrosis.
• Major symptoms: Hematuria (gross or microscopic), proteinuria (foamy urine; in severe cases, ≥3.0 g per day, resulting in nephrotic syndrome), generalized or facial and limb edema, hypertension, decreased urine output (oliguria), general fatigue, and others.
• Examples of clinical forms: Acute post-infectious glomerulonephritis (hematuria, edema, and hypertension within days to weeks), nephrotic syndrome (massive proteinuria and severe edema), rapidly progressive glomerulonephritis (rapid deterioration of kidney function within weeks to months), and asymptomatic urinary abnormalities (hematuria/mild proteinuria on urinalysis).

Treatment Methods

• General principles: Identify the cause and provide standard treatment according to the cause. For immune-mediated lesions, immunosuppressive treatment (steroids, cyclophosphamide, CNIs, MMF, etc.) is used, but the choice and duration of medication are determined according to the pathology and clinical course.
• Medication treatment
  • Immunosuppressants: Steroids (frequently used for initial treatment), with additional immunosuppressants as needed (e.g., cyclophosphamide, mycophenolate, etc.).
  • Blood pressure and proteinuria control: ACE inhibitors or angiotensin receptor blockers (standard treatments that are beneficial for reducing proteinuria and preserving kidney function). The standard target blood pressure is adjusted for each individual, but maintaining diastolic blood pressure at 80 mmHg or below is recommended (according to the table-based recommendation).
  • Edema control: A low-salt diet (strict salt restriction) and, if necessary, diuretics (monitor for possible worsening of kidney function).
• Procedures/surgery: Surgical treatment is generally uncommon. Kidney tissue examination (biopsy) is important in determining the diagnosis and treatment (performed according to indications).
• Precautions (during treatment)
  • Monitoring for infections and other side effects of immunosuppressants is necessary.
  • Diuretics may worsen kidney function, so monitoring of kidney function and electrolytes is essential.
  • Avoid painkillers (NSAIDs), unverified herbal medicines, and folk remedies.
  • Women of childbearing age: Pregnancy can affect the disease and increase the risk of complications, so prior consultation with a specialist is necessary.
• Prevention and management of complications: Prevent progression to chronic renal failure (ESRD) through active control of hypertension and proteinuria. If ESRD progresses, dialysis or kidney transplantation is necessary.

Outpatient Visit Checkpoints (Including Preparation Items and Example Questions)

• Items to bring (recommended)
  • A list of all medications and supplements currently being taken (including dosage and time of administration).
  • Recent blood pressure records (if possible, several days of home blood pressure measurements).
  • Copies or printouts of recent test results (urinalysis, blood tests [creatinine, eGFR, albumin, etc.], and imaging tests).
  • Records of changes in urine (color, foam, frequency, and whether there is pain during urination), and photographs or records of the location and onset date if edema has developed.
  • If there are previous kidney biopsy or pathology findings, the relevant result documents.
• Symptom records to discuss with the doctor during the outpatient visit
  • When the symptoms began and their progression (whether they started suddenly or have gradually worsened)
  • History of fever, respiratory symptoms, or skin infections (to identify infection-related causes)
  • Recent clinical stressors (medications, pregnancy, infections, etc.)
• Tests to review (the doctor may request these)
  • Urine protein and microscopy (microscopic hematuria), 24-hour urine protein, or urine protein/creatinine ratio (UACR/PCR)
  • Blood tests: Creatinine, electrolytes, albumin, blood coagulation and immune-related tests (if necessary)
  • Imaging: Kidney ultrasound (to check for structural abnormalities)
• Examples of questions that can be asked right away during the outpatient visit (including general questions to ask the doctor; natural overlap with the section below is acceptable)

Examples of General Questions to Ask the Doctor

• "What are the expected side effects of this medication (or treatment), and how can they be prevented?"
• "What is the current prognosis for my kidney function? How likely is it to progress to chronic renal failure?"
• "Could you explain specifically my blood pressure target and the lifestyle guidelines I should follow (salt intake, exercise, etc.)?"
• "What preventive measures should I take to reduce the risk of infection during treatment?"

Examples of Disease-Specific Questions (1–2)

• "Why and when is a kidney biopsy recommended in my condition? What diagnostic and treatment changes are expected from the biopsy?"
• "How will pregnancy (or plans for pregnancy) affect my current disease process and treatment, and what is the specific management plan before, during, and after pregnancy?"