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Glomerulonephritis (Bright's Disease)

What Is Glomerulonephritis?

Glomerulonephritis (GN) is inflammation of the glomeruli, which are structures in your kidneys that are made up of tiny blood vessels. These knots of vessels help filter your blood and remove excess fluids. If your glomeruli are damaged, your kidneys will stop working properly and you can go into kidney failure.

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

What Are the Causes of Glomerulonephritis?

Glomerulonephritis (GN) can be acute or chronic.

Acute GN

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

  • strep throat
  • systemic lupus erythematosus (SLE), which is also called lupus
  • Goodpasture’s syndrome, which is a rare autoimmune disease in which antibodies attack your kidneys and lungs
  • amyloidosis, which occurs when abnormal proteins that can cause harm build up in your organs and tissues
  • Wegener’s granulomatosis, which is a rare disease that causes inflammation of the blood vessels)
  • polyarteritis nodosa, which is a disease in which cells attack arteries

Heavy use of non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen and naproxen, may also be a risk factor.

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 ultimately lead to complete kidney failure.

A genetic disease can sometimes cause chronic GN. 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 of GN may make you more likely to develop the chronic form later on. Exposure to some hydrocarbon solvents may increase the risk of chronic GN.

Chronic GN doesn’t always have a clear cause. Twenty-five percent of people with the condition have no history of kidney disease.

What Are the Symptoms of Glomerulonephritis?

Acute GN

Early symptoms of acute GN 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

Chronic GN

The chronic form of glomerulonephritis can creep up without any symptoms. There may be slow development of symptoms similar to the acute form. Some symptoms include:

  • blood or excess protein in your urine, which 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
  • frequent nosebleeds

Kidney Failure

Your GN may be so advanced that you’re 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

How Is Glomerulonephritis Diagnosed?

The first step in diagnosis is to have a urinalysis test. A routine physical exam for another condition can also lead to the discovery of GN. Blood and protein in the urine during urinalysis are important markers for the disease.

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

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

Blood tests may show:

  • anemia, which is a low level of red blood cells
  • abnormal albumin levels
  • abnormal blood urea nitrogen
  • high creatinine levels

Immunology testing can also 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:

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

What Treatments Are Available for Glomerulonephritis?

Depending on the type of GN, the cause and treatment may be different.

One treatment is to control high blood pressure, especially if that’s the underlying cause of the GN. Blood pressure may be very hard to control when your kidneys aren’t working properly. If this is the case, your doctor may prescribe blood pressure medications, including angiotensin-converting enzyme inhibitors (ACE inhibitors) such as:

  • captopril
  • lisinopril
  • perindopril

Your doctor may also prescribe angiotensin receptor blockers (ARBs), such as:

  • losartan
  • irbesartan
  • valsartan

Corticosteroids may also be used if your immune system is attacking your kidneys. They reduce the immune response.

Another method to reduce the immune-triggered inflammation is plasmapheresis. This process removes the fluid part of the blood (plasma) and replaces it with intravenous (IV) fluids or donated plasma (with no antibodies).

For chronic GN, you’ll 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. As usual, check with your general practitioner or kidney specialist for guidelines about diet restrictions or supplements.

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

What Are the Complications Associated with Glomerulonephritis?

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 retention in your body. You can develop high blood pressure, high cholesterol, and swelling throughout your body. Corticosteroids treat this condition. Eventually, nephrotic syndrome will lead to end-stage renal disease if it doesn’t come under control.

The following conditions can also occur due to GN:

  • acute kidney failure
  • chronic kidney disease
  • electrolyte imbalances, such as high levels of sodium or potassium
  • chronic urinary tract infections
  • congestive heart failure due to retained fluid or fluid overload
  • pulmonary edema due to retained fluid or fluid overload
  • high blood pressure
  • malignant hypertension, which is rapidly increasing high blood pressure
  • increased risk of other infections

What Is the Long-Term Outlook?

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

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

The following are positive steps to recover from GN and prevent future episodes:

  • maintaining a healthy weight
  • restricting salt in your diet
  • restricting protein in your diet
  • restricting potassium in your diet
  • quitting smoking

Meeting with a support group can also be a helpful way for you to deal with the emotional stress of having a kidney disease.

Content licensed from:

Written by: Christine Case-Lo
Published on: Nov 04, 2015
Medically reviewed on: Mar 16, 2017: Carissa Stephens, RN, CCRN, CPN

This feature is for informational purposes only and should not be used to replace the care and information received from your health care provider. Please consult a health care professional with any health concerns you may have.
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