GLOMERULONEPHRITIS

What is it?

Glomerulonephritis is the term used to describe a group of kidney diseases where the filtering part of the kidney (glomerulus) is inflamed. Sometimes the name is shortened to nephritis.

Who gets it?

Acute glomerulonephritis is usually a disease of children, but can occur at any age. Males have the disease more frequently than females.

Patients with acute glomerulonephritis often have evidence of a recent infection. The most common infection causing glomerulonephritis is a streptococcal infection of the throat or skin. Other serious bacterial and viral infections may also be associated with acute glomerulonephritis.

What are the symptoms?

About 10 days after the start of an infection of the throat or skin, the patient will frequently note a fall in the urine output and the urine looks "smoky or rusty" (often described as coffee or cola colored). There can be burning upon urination.

Fluid retention is common, typically involving the face, eyelids and hands. This is most notable in the morning when rising. Shortness of breath and cough can occur because of fluid congestion in the lungs. High blood pressure is common. Although many or all of these symptoms and signs can occur, it is important to understand that these can vary.

In addition, systemic and hereditary diseases have symptoms and signs which are similar to acute glomerulonephritis. The diseases in this category include systemic lupus erythematous, Henoch-Schonlein purpura, many types of vasculitis and Goodpasture's Disease. However, the above diseases generally do not improve and treatment is needed.

Other kidney disease of unknown cause may also have qualities which are similar to acute glomerulonephritis. These diseases are called membrano-proliferative glomerulonephritis, IgA nephropathy, and focal and segmental glomerulonephritis. In general, these diseases do not show improvement either on their own or with treatment.

The wide variety of diseases that fit in the category of chronic glomerulonephritis generally have a longer course. They have lengthy periods without any symptoms. During this time, there is progressive damage of kidney tissue. In the early stages, frequently the only findings are an abnormal urinalysis (for example, red blood cells, white blood cells and protein in the urine).

High blood pressure can be found, especially when there is a decrease in kidney function for the first time. As the disease progresses, there is swelling of the legs (edema) and persistent high blood pressure. High blood pressure is often difficult to treat. Signs of chronic kidney failure (uremia) are noted when there is a severe loss of kidney function. The signs include:

1. loss of appetite;
2. nausea and vomiting;
3. extreme fatigue, even after a night's sleep, and a severe loss of energy;
4. difficulty sleeping;
5. itching and dry skin; and
6. muscle cramps, especially at night.

What tests will the Doctor want to do?

The signs and symptoms noted above are the first clues to the diagnosis. In acute glomerulonephritis, blood tests can indicate a recent streptococcal infection. Other forms of glomerulonephritis can be detected by special blood tests that show the type of damage occurring in the kidney without learning the exact cause of the injury. Also, cultures of the throat, skin, or other known areas of local infection can identify the bacteria which is causing the problem.

Examination of the urine can show the presence of blood, protein, and other elements. Other blood tests which point out inflammation in the kidney can show how much kidney function is lost. Often it is necessary to do a kidney biopsy (removal of a tiny piece of tissue by a special needle). This is done under local anesthesia to establish the exact diagnosis and determine the short and long term outlook for the patient. Sometimes the biopsy is necessary for the doctor to plan the best possible treatment for the patient.

What is the treatment?

There is no specific treatment for acute glomerulonephritis. This illness will usually heal completely within 3-12 months after onset. With both acute and chronic glomerulonephritis, it is important to treat high blood pressure. Uncontrolled high blood pressure can lead to a rapid decrease in kidney function. Diuretics often are used to control excess retention of body fluid. In chronic glomerulonephritis, steroids and other drugs have been used. However, most often this treatment is not successful in treating the cause of chronic glomerulonephritis.

A special blood filtering process called plasmapheresis has been used in some special types of glomerulonephritis, and at times, there have been very good results with this treatment. Restricting protein, salt and sometimes potassium in the diet may be a major part in the conservative treatment used by your doctor. A dietitian can help you with this part of your care. Close follow up with your doctor is necessary so that he/she can treat the known complications of chronic kidney disease.