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Glomerulonephritis

Definition


Disease: Glomerulonephritis Glomerulonephritis
Category: Kidney diseases
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Disease Definition:

Glomerulonephritis, also called glomerular disease, is one type of kidney disease that damages the kidneys' ability to remove waste and excess fluids. This disease could be either chronic coming on gradually, or it could be acute occurring as a sudden attack of inflammation.

 

Primary glomerulonephritis is when glomerulonephritis occurs on its own. Secondary glomerulonephritis is when another disease is the cause, such as diabetes or lupus. Depending on the type of glomerulomephritis that a person has, their treatment will be determined.
 

Work Group:


Prepared by: Scientific Section

Symptoms, Causes

Symptoms:

Someone’s signs and symptoms of glomerulonephritis will depend on the type of the disease and its cause. The first sign that something is wrong could come either from the results of a routine urinalysis or from the symptoms that the patient experiences, such as:

 

  • Foamy urine due to excess protein (proteinuria)
  • Less frequent urination than usual
  • Hypertension
  • Fatigue from kidney failure or anemia
  • Hematuria, which is when the urine is diluted, iced-tea-colored or cola-colored due to the presence of red blood cells in it. 
  • Edema, which means fluid retention, with evident swelling in the face, abdomen, hands and feet.

 

In case a person has a condition that is associated with glomerulonephritis, they should make an appointment to see their doctor. However, if someone’s experiencing any of the signs and symptoms of glomerulonephritis, they should see their doctor promptly.
 

Causes:

There are approximately 1 million tiny filters called glomeruli in each of a person’s kidneys, which attach to the opening of a small fluid-collecting tube called tubule. Each glomerulus and tubule forms a nephron, which is the functional unit of the kidneys. As blood passes through the kidneys, it is filtered by the glomeruli, and then returned to the bloodstream. By saving needed substances such as protein, the tubules modify what the glomeruli filter. As urine, the waste goes to the bladder through a tube called ureter from each kidney, and when the person urinates, it passes out of the body.

 

A person’s kidneys may be damaged by glomerulonephritis, which is an inflammation of the glomeruli. Due to this disease, the kidneys lose their filtering ability and allow dangerous levels of fluid and waste to accumulate in the body, depriving the bloodstream of protein because it is excreted in the urine. This condition is called kidney failure. Mostly, the cause of glomerulonephritis is not known. Some of its known causes include:

 

INFECTIONS:

 

Post-streptococcal glomerulonephritis:

After a strep infection in the throat, or in some rare cases, on the skin (impetigo), glomerulonephritis may develop.

 

Viral infections:

HIV (human immunodeficiency virus), which causes AIDS, and the hepatitis B and hepatitis C viruses that primarily affect the liver, are some of the viral infections that could trigger glomerulonephritis.

 

Bacterial endocarditis:

Infection of one or more or the heart valves could be caused when bacteria spread through a person’s bloodstream and lodge in their heart. People with a heart defect, such as a damaged or artificial heart valve, are at great risk.

 

IMMUNE DISEASES:

 

Goodpasture's syndrome:

This syndrome causes hemorrhage (bleeding) into the lungs as well as glomerulonephritis. Goodpasture's syndrome is a rare immune lung disorder that may mimic pneumonia.

 

Lupus:

This chronic inflammatory disease could affect many parts of the body, including joints, lungs, kidneys, skin, heart and blood cells.

 

IgA nephropathy:

This is a primary glomerular disease that results from deposits of immunoglobulin A (IgA) in the glomeruli, and it causes recurrent episodes of blood in the urine. This disorder, which is more common in men than in women, could progress for years without showing any noticeable signs or symptoms.

 

VASCULITIS:

 

Wegener's granulomatosis:

Small and medium blood vessels in the lungs, upper airways and kidneys are affected by this form of vasculitis.

 

Polyarteritis:

Small and medium blood vessels in many parts of the body are affected by this form of vasculitis, including the intestines, kidneys and heart.

 

CONDITIONS THAT COULD CAUSE SCARRING OF THE GLOMERULI:

 

Diabetic kidney disease:

Anyone with diabetes could be affected with diabetic kidney disease, also known as diabetic nephropathy. This disease takes years to develop. In order to prevent or slow kidney damage, a person should have good control of their blood sugar levels and blood pressure.

 

High blood pressure:

High blood pressure could cause damage to the kidneys and their ability to perform their normal functions. Because glomerulonephritis reduces the function of kidneys, it could also cause high blood pressure.

 

Focal segmental glomerulosclerosis:

This condition could occur for no known reason or it could result from another disease. It is characterized by scattered scarring of some of the glomeruli.

 

Sometimes, after a bout of acute glomerulonephritis, chronic glomerulonephritis occurs. In people who don't have a history of kidney disease, the first indication of this disease will be chronic kidney failure. In some rare cases, this disease could be inherited and run in families. Alport syndrome, which is an inherited form of this disease, could also involve hearing or vision impairment.
 

Complications

Complications:

Some of the complications that could occur due to glomerulonephritis include:

 

Acute kidney failure:

Waste products could accumulate rapidly due to loss of function in the filtering part of the nephron. As a result, the patient may need an emergency dialysis, which is an artificial means of removing extra fluids and waste from the blood, typically by a dialyzer, an artificial kidney machine.

 

Chronic kidney failure:

This is an extremely serious complication. In this condition, the kidneys gradually lose their function. A person may have end-stage kidney disease when the function of their kidneys is less than 10% of normal capacity. In order to sustain life, this condition requires dialysis or a kidney transplant.

 

Nephrotic syndrome:

This syndrome is characterized by high protein levels in the urine resulting in low protein levels in the blood, high blood cholesterol and edema of the eyelids, feet and abdomen. This group of signs and symptoms accompany glomerulonephritis and other conditions that affect the filtering ability of the glomeruli.

 

High blood pressure:

Someone’s blood pressure may be raised due to damage to their kidneys and the resulting buildup of wastes in the bloodstream.
 

Treatments:

Treatment of glomerulonephritis and its outcome will depend on:

 

  • The underlying cause
  • The type of the disease (acute or chronic)
  • The type and severity of the signs and symptoms

 

There are some types of glomerulonephritis that improve on their own without requiring any specific treatment. One of these types is the one that follows a strep infection.

 

The patient may be prescribed one of several medications in order to control their high blood pressure and slow the decline in kidney function. These medications may include:

 

  • ACE (angiotensin-converting enzyme) inhibitors.
  • Angiotensin II receptor agonists
  • Diuretics

 

In order to treat the underlying cause of glomerulonephritis, the patient may also be prescribed other drugs:

 

Lupus or vasculitis:

Corticosteroids and immune-suppressing drugs are usually prescribed for these conditions.

 

Strep or other bacterial infection:

The patient will be prescribed an appropriate antibiotic for this condition.

 

IgA nephropathy:

Although it is still under study, but in some people, fish oil supplements have been successful.

 

Goodpasture's syndrome:

In some cases, in order to treat this syndrome, plasmapheresis is used, which is a mechanical process. By taking the plasma out of the blood and replacing it with fluid or donated plasma, antibodies are removed from the blood.

 

THERAPIES FOR ASSOCIATED KIDNEY FAILURE:

Temporary dialysis could help remove excess fluid and control high blood pressure in the case of acute glomerulonephritis and acute kidney failure. Kidney dialysis and kidney transplantation are the only long-term therapies for end-stage kidney failure, and dialysis becomes the only option when a transplant isn't possible, usually due to poor general health.
 

Prognosis:

Not available

Expert's opinion

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