Glomerulonephritis

Glomerulonephritis is a condition affecting the glomeruli in the kidneys. Severe cases of the disease result in renal failure. When the glomeruli are not able to filter waste from the bloodstream, proteins go into the urine, and toxic substances that should be excreted remain in the blood.

Definition & Facts

Glomerulonephritis is a disease that affects the glomeruli, and it is a type of nephritis or inflammation of the kidneys. The glomeruli are a group of tiny blood vessels in the kidney that filter blood to remove excess water and waste. The waste material is passed out through urine.

Glomerulonephritis can be acute or chronic. A case of acute glomerulonephritis occurs suddenly, often as a result of diseases such as lupus or diabetes. On the other hand, chronic glomerulonephritis occurs slowly as the gradual destruction of the glomeruli. Complete destruction of the glomeruli results in kidney failure. During kidney failure, blood goes unfiltered, and toxic waste remains in the bloodstream. When these wastes accumulate, it can be fatal.

Symptoms & Complaints

• Swelling of the face, especially in the morning.
• Red or brown urine which usually has traces of blood
• Reduced urination in comparison to an individual's average urination frequency

Chronic nephritis develops over a period often without any visible symptoms. Several years of damage to the glomeruli leads to kidney failure. Some of the early symptoms include

• Urine that has bubbles or looks like foam
• High blood pressure
• Hematuria which is a condition where there is blood or other proteins in the urine. Since the kidneys cannot filter, urine contains nutrients that should be absorbed back into the bloodstream.
• Swelling of the feet and extremities - a condition referred to as edema
• Frequent urination especially at night.

Causes

Glomerulonephritis, whether acute or chronic, is caused by conditions that affect the glomeruli in the kidneys. One common cause is the streptococcal infection, which causes strep throat as well as impetigo, a highly contagious skin disorder. The body produces antibodies to fight these infections. In patients with glomerulonephritis, these antibodies cause the glomeruli to become inflamed.

Viral infections such as hepatitis and HIV infection are known to cause glomerulonephritis. Autoimmune diseases such as lupus that cause inflammation of body parts can affect the kidneys leading to glomerulonephritis. The Goodpasture syndrome attacks the glomeruli and causes bleeding in the lungs and kidneys. IgA nephropathy occurs when immunoglobulin are deposited in the glomeruli, and it is the most common cause of glomerulonephritis. It causes blood to leak out into the urine; any sign of blood in the urine calls for immediate doctor’s attention because it may be an indication of IgA nephropathy.

Vasculitis or the inflammation of blood vessels is another cause of glomeruli diseases. Granulomatosis with polyangiitis is a type of vasculitis that can cause inflammation of the glomeruli. Scarring of the glomeruli also leads to glomerulonephritis. Diabetic nephropathy develops slowly but damages the glomeruli; it is a complication of diabetes mellitus.

Hypertension or high blood pressure affects the ability of the kidneys to function normally. High blood pressure can be both a cause and a result of glomerulonephritis. In some cases, acute glomerulonephritis becomes chronic if not properly treated, which causes eventual kidney failure.

Diagnosis & Tests 

When the patient notices symptoms of glomerulonephritis such as blood in the urine, it is important to seek a doctor’s opinion. Health care providers will run several tests to identify the presence, cause, and progress of glomerulonephritis. A blood test will be taken to measure creatinine levels in the blood. Creatinine is produced in the muscles and removed from the blood through the kidneys. Its presence in the blood is indicative of a problem in the kidneys.

A kidney biopsy is the most effective diagnosis. A tissue sample or biopsy of the kidneys is taken out through a special needle in a process called fine-needle aspiration. The sample is then analyzed under a microscope to confirm the presence of glomerulonephritis and the extent of the damage.

Clinical urine tests are also carried out in two ways. First, they may do a urine test strip or urine dipstick test in which the health care providers dip a specialized strip in a urine sample that changes color in the presence of proteins or blood. Healthy working kidneys are supposed to filter proteins away from the urine, so this tests that function. Secondly, the urine sample may be sent to a lab for complete analysis.

X-rays and ultrasounds of the kidneys are also carried out to see damage to the kidneys that may affect the glomeruli function. Since certain medical conditions cause glomerulonephritis, special blood tests are done to identify the diseases. Some of the diseases tested include lupus, vasculitis, and viruses such as hepatitis.

Treatment & Therapy

Kidney specialists treat glomerulonephritis according to the cause. Basic treatment begins with the recommendation for dietary change. Patients are advised to reduce intake of foods with too much salt or potassium and adopt a low sodium diet. Regulating blood sugar will also prevent the kidneys from becoming overtaxed.

Immune suppressants are used to treat cases of nephritis caused by problems in the immune system. The treatment requires monitoring and adjusting since suppressing the immune system can cause other infections. Corticosteroids are steroid treatments used to reduce swelling in the glomeruli. Prednisone is a steroid commonly used to reduce inflammation by suppressing the immune system.

Blood pressure is managed with antihypertensive drugs to avoid further damage to the kidneys. People suffering from glomerulonephritis most often have high cholesterol levels. The levels are reduced to prevent further complications such as heart and vascular diseases. Plasma exchange is used in severe cases to replace blood plasma with antibodies causing inflammation in the glomeruli. The procedure involves connecting the patient with a machine that slowly removes some of the blood.

Kidney diseases and failures are treated through dialysis and kidney transplants. People with glomerulonephritis require frequent vaccinations against infectious disease because of their weakened immune systems. A malfunctioning kidney makes them susceptible to the diseases.

Prevention & Prophylaxis

Preventing viral infections that are sexually transmitted such as hepatitis and HIV can also help prevent glomerular diseases. People with chronic glomerulonephritis should be vigilant about maintaining healthy blood pressure to avoid further damage to the kidneys.