A REVIEW of the clinical aspects of acute glomerulonephritis demonstrates that the signs and symptoms of circulatory congestion do occur in a significant proportion of cases.1-3 Some patients demonstrate pulmonary congestion visible on x-ray film alone, but are asymptomatic; others have a few pulmonary rales; a few present with the picture of acute pulmonary edema, and the underlying diagnosis may be overlooked.
Severe circulatory failure associated with acute glomerulonephritis is not necessarily responsive to digitalis or diuretic therapy. It may progress rapidly in spite of rigid restriction of fluid intake and may demand vigorous removal of some of the excess plasma volume. Among the techniques available are hemodialysis, peritoneal dialysis, and phlebotomy. Hemodialysis and peritoneal dialysis are difficult and may carry considerable risk. In addition, they are not practicable in that the few hours' preparation time needed may be critical.
Phlebotomy is not generally recognized as an effective method.