Glomerulonephritis

The glomeruli are structures in your kidneys made up of tiny blood vessels. These knots of vessels help filter blood and remove excess fluid. If your glomeruli are damaged, your kidneys will stop longer work properly, and your body can go into kidney failure. Conditions that damage the glomeruli are collectively referred to as glomerulonephritis (GN).

Glomerulonephritis is a serious illness that can be life threatening and requires immediate treatment. Sometimes this condition is called nephritis or nephrotic syndrome. There can be both acute (sudden) glomerulonephritis and chronic (long-term) glomerulonephritis.

There are two categories of glomerulonephritis: acute and chronic.

Causes of Acute GN

Acute GN can start in response to an infection such as strep throat or an abscessed tooth. It may be caused by problems with your immune system overreacting to the infection. This may go away on its own without treatment. If it doesn’t go away, immediate treatment is necessary to prevent long-term damage to your kidneys. Illnesses that have been known to trigger GN include:

• strep throat
• systemic lupus erythematosus (also called SLE or lupus)
• Goodpasture’s syndrome (a rare autoimmune disease where antibodies attack the kidneys and lungs)
• amyloidosis (proteins that are deposited in organs and tissue, and can cause harm)
• Wegener’s granulomatosis (a rare disease that causes inflammation of the blood vessels)
• polyarteritis nodosa (a disease where cells attack arteries)

Heavy use of NSAID pain relievers (ibuprofen, naproxen) may also be a risk factor.

Causes of Chronic GN

The chronic form of GN can develop over several years with no or very few symptoms. This can cause irreversible damage to your kidneys and lead to complete kidney failure.

Chronic GN may sometimes be caused by a genetic disease. Hereditary nephritis occurs in young men with poor vision and poor hearing.

Immune diseases may also cause chronic GN. A history of cancer may also put you at risk. Having the acute form may make you more likely to develop the chronic form later on. Exposure to some hydrocarbon solvents may increase the risk of chronic GN.

Sometimes there is no clear reason why you develop chronic GN. Twenty-five percent of people with the condition have no prior history of kidney disease.

Symptoms of Acute GN

Early symptoms of acute glomerulonephritis include:

• puffiness in the face (edema)
• urinating less often
• blood in your urine (dark, rust-colored urine)
• extra fluid in your lungs causing coughing
• high blood pressure

Symptoms of Chronic GN

Often, the chronic form of glomerulonephritis can creep up without any symptoms. Sometimes there may be slow development of symptoms similar to the acute form. Some symptoms which may occur include:

• blood or protein in urine (may be microscopic and show up in urine tests)
• high blood pressure
• swelling in ankles and face (edema)
• frequent nighttime urination
• bubbly or foamy urine (from excess protein)
• abdominal pain
• nosebleeds

Symptoms of Kidney Failure

Your GN may be so advanced that you are developing kidney failure. You may have some of the following symptoms:

• fatigue
• lack of appetite
• nausea and vomiting
• insomnia
• dry, itchy skin
• muscle cramps at night

The first step in diagnosis is to have a urinalysis test. However, GN is often discovered when you have a routine physical to treat another condition. Blood and protein in the urine during urinalysis are important markers for the disease.

More urine testing may be done to check important signs of kidney health, including:

• creatinine clearance
• total protein in urine
• urine concentration
• urine specific gravity
• urine red blood cells (RBCs)
• urine osmolality

Blood tests may show anemia (low level of red blood cells), abnormal albumin levels, abnormal blood urea nitrogen, and high creatinine levels.

Immunology testing may also be done to check for things such as:

• antiglomerular basement membrane antibodies
• antineutrophil cytoplasmic antibodies
• antinuclear antibodies
• complement levels

These are all signs that your immune system may be damaging your kidneys.

A biopsy (a small sample taken with a needle) of the kidneys may be necessary to confirm the diagnosis.

To learn more about your condition, you may also have scans such as:

• computed tomography (CT) scan
• kidney ultrasound
• chest X-ray
• intravenous pyelogram (X-ray of kidneys with dye)

Different types of glomerulonephritis have varying causes and may require different treatments.

One of the first focuses of therapy is to control high blood pressure. Blood pressure may be very hard to control when your kidneys are malfunctioning. If this is the case, your doctor may prescribe blood pressure medications, including angiotensin-converting enzyme inhibitors (i.e. captopril, lisinopril, perindopril, etc.) or angiotensin receptor blockers (i.e. losartan, irbesartan, valsartan, etc.).

Other medications such as corticosteroids may be prescribed reduce your immune response if your immune system is attacking your kidneys.

Another method used to reduce the immune-triggered inflammation is plasmapheresis. The fluid part of the blood (plasma) is removed and replaced with intravenous (IV) fluids or donated plasma (with no antibodies).

For the chronic form of the disease, you will need to reduce the amount of protein, salt, and potassium in your diet. Additionally, you must watch how much liquid you drink. Calcium supplements may be recommended, and you may need to take diuretics to reduce swelling.

If your condition becomes advanced and you develop kidney failure, you may need to have dialysis where your blood is filtered by a machine. Eventually you may need a kidney transplant.

Acute GN, if caught early, can be temporary and reversible. Chronic GN may be slowed with early treatment. But if your GN worsens, it will likely lead to reduced kidney function, chronic kidney failure, and end-stage renal disease.

Glomerulonephritis can lead to nephrotic syndrome, where you lose large amounts of protein in your urine. This leads to a lot of fluid and salt retained in your body. You develop high blood pressure, high cholesterol, and swelling throughout your body. This is treated with corticosteroids. If the syndrome cannot be controlled, then eventually end-stage renal disease will result.

Severe kidney damage, kidney failure, and end-stage renal disease may eventually require dialysis and the need for a kidney transplant.

The following conditions can also occur due to GN:

• acute kidney failure
• chronic kidney disease
• end-stage renal disease
• acute nephrotic syndrome
• electrolyte imbalances (high levels of sodium, potassium, etc.)
• chronic urinary tract infections
• congestive heart failure due to retained fluid or fluid overload
• pulmonary edema due to retained fluid or fluid overload
• hypertension, malignant hypertension (rapidly increasing high blood pressure)
• increased risk of other infections