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Glomerulonephritis




Introduction

Glomerulonephritis (glo-mer-u-lo-nuh-FRI-tis) is a type of kidney disease that hampers your kidneys' ability to remove waste and excess fluids. Also called glomerular disease, glomerulonephritis can be acute, referring to a sudden attack of inflammation, or chronic, which comes on gradually.

Glomerular disease can be part of a systemic disease, such as lupus or diabetes, or it can be a disease by itself — primary glomerulonephritis. Treatment depends on the type of glomerulonephritis you have.

Signs and symptoms

Signs and symptoms of glomerulonephritis may depend on whether you have the acute or chronic form, and the cause. Your first indication that something is wrong may come from symptoms or from the results of a routine urinalysis. Signs and symptoms may include:
  • Cola-colored or diluted iced-tea-colored urine from red blood cells in your urine (hematuria).
  • Foam in the toilet water from protein in your urine (proteinuria).
  • High blood pressure (hypertension).
  • Fluid retention (edema) with swelling evident in your face, hands, feet and abdomen.
  • Fatigue from anemia or kidney failure.
  • Less frequent urination than usual.
Causes

Your kidneys are two bean-shaped, fist-sized organs situated at the small of your back, just below your rib cage, one on each side of your spine. Blood enters your kidneys through arteries from your aorta, the large artery that carries blood away from your heart. Each kidney contains approximately 1 million tiny filters (glomeruli), each of which is attached to the opening of a small fluid-collecting tube (tubule). Each glomerulus and tubule form a nephron, the functional unit of the kidneys.

The glomeruli filter your blood as it passes through your kidneys. After being filtered by the glomeruli, blood travels through veins in the kidneys back to your bloodstream. The waste, after being modified by the tubules, goes to your bladder as urine through a tube from each kidney (ureter) and passes out of your body when you urinate.

Every day about 1.5 to 2 quarts of extra water with waste products leave your body as urine. When your kidneys lose their filtering ability, dangerous levels of fluid and waste accumulate in your body, a condition known as kidney failure.

Many causes of glomerulonephritis
Glomerulonephritis is one disorder that can lead to kidney failure. There are many causes of glomerulonephritis. They include those related to infections, immune diseases, inflammation of the blood vessels (vasculitis) and conditions that scar the glomeruli.

Often, however, the exact cause is initially unknown. Here are some of the known causes:

Infections
  • Post-streptococcal glomerulonephritis. Glomerulonephritis may develop after a strep infection in your throat or, rarely, on your skin (impetigo). Post-infectious glomerulonephritis is becoming less common, most likely because of rapid and complete antibiotic treatment of most streptococcal infections.
  • Bacterial endocarditis. Bacteria can occasionally spread through your bloodstream and lodge in your heart, causing an infection of the valvular tissues inside the heart. Those at greatest risk are people with a heart defect, such as a damaged or artificial heart valve.
  • Viral infections. Among the viral infections that may trigger glomerulonephritis are the human immunodeficiency virus (HIV), which causes AIDS, and the hepatitis B and hepatitis C viruses, which affect the liver and can become chronic infections.
Immune diseases
  • Lupus. A chronic inflammatory disease, lupus can affect many parts of your body, including your skin, joints, kidneys, blood cells, heart and lungs.
  • Goodpasture's syndrome. A rare immune lung disorder that may mimic pneumonia, Goodpasture's syndrome causes bleeding (hemorrhage) into your lungs as well as glomerulonephritis.
  • IgA nephropathy. Characterized by recurrent episodes of blood in the urine, this condition results from deposits of immunoglobulin A (IgA) in the glomeruli. IgA nephropathy can progress for years with no noticeable symptoms. The disorder seems to be more common in men than in women.
Vasculitis
  • Polyarteritis. This form of vasculitis affects small and medium blood vessels in many parts of your body, such as your heart, kidneys and intestines.
  • Wegener's granulomatosis. This form of vasculitis affects small and medium blood vessels in your lungs, upper airways and kidneys.
Conditions that cause scarring of the glomeruli
  • High blood pressure. Damage to your kidneys and their ability to perform their normal functions can occur as a result of high blood pressure. Glomerulonephritis can also cause high blood pressure because it reduces kidney function.
  • Diabetic kidney disease. Possibly the most common cause of end-stage kidney disease in the United States, diabetic kidney disease (diabetic nephropathy) can affect anyone with diabetes. Diabetic nephropathy usually takes years to develop, and maintaining good control of blood sugar levels and controlling blood pressure may prevent or slow the kidney damage.
  • Focal segmental glomerulosclerosis. Characterized by scattered scarring of some of the glomeruli, this condition may result from another disease or occur for no known reason.
Chronic glomerulonephritis sometimes develops after a bout of acute glomerulonephritis. In some people there's no history of kidney disease at all, and the first indication of chronic glomerulonephritis is chronic kidney failure. Infrequently, chronic glomerulonephritis runs in families. In many cases, no one knows the cause.

Treatment

Treatment and outcome of glomerulonephritis depend on whether you have an acute or chronic form of the disease, on the underlying cause, and on the type and severity of your signs and symptoms. Some cases of acute glomerulonephritis, especially those that follow a strep infection, often improve on their own and require no specific treatment.

To control your high blood pressure and slow the decline in kidney function, your doctor may prescribe one of several medications, including:
  • Diuretics.
  • Angiotensin-converting enzyme (ACE) inhibitors.
  • Angiotensin II receptor agonists.
  • Calcium channel blockers.
  • Beta blockers.
Your doctor also may prescribe drugs to treat the underlying cause of glomerulonephritis:
  • Strep or other bacterial infection. Your doctor likely will prescribe an appropriate antibiotic.
  • Lupus or vasculitis. Doctors often prescribe corticosteroids and immune-suppressing drugs.
  • IgA nephropathy. Fish oil supplements have been successful in some people with IgA nephropathy and are under study.
  • Goodpasture's syndrome. Plasmapheresis is sometimes used to treat people with Goodpasture's syndrome. Plasmapheresis is a mechanical process that removes antibodies from your blood by taking the plasma out of your blood and replacing it with fluid or donated plasma.
Therapies for associated kidney failure
For acute glomerulonephritis and acute kidney failure, temporary dialysis can help remove excess fluid and control high blood pressure. The only long-term therapies for end-stage kidney failure are kidney dialysis and kidney transplantation. When a transplant isn't possible, often because of poor general health, dialysis becomes the only option.

Prevention

There's no way to prevent most forms of glomerulonephritis. However, you can seek prompt treatment of a strep infection causing a sore throat or impetigo. To prevent infections, such as HIV and hepatitis, that can lead to some forms of glomerulonephritis, follow safe sex guidelines and avoid intravenous drug use. Controlling your blood sugar may prevent diabetic nephropathy, and controlling your blood pressure makes damage to your kidneys caused by hypertension less likely.


Information obtained from National Institute of Health
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