GLOMERULONEPHRITIS

What is glomerulonephritis?

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.

Are there different types of glomerulonephritis?

Yes, there are two type of glomerulonephritis: acute glomerulonephritis (acute nephritis) and chronic glomerulonephritis (chronic nephritis). With acute glomerulonephritis, there is a tendency for spontaneous recovery. In the case of chronic glomerulonephritis, progressive damage of kidney tissue occurs. Signs of the disease may include protein and blood in the urine and usually high blood pressure. Chronic glomerulonephritis is the most common cause of chronic kidney failure leading to end stage renal disease (ESRD). There is another form of glomerulonephritis called rapidly progressive glomerulonephritis (RPGN). RPGN leads to kidney failure fairly quickly. This disease is of unknown cause, it is irreversible, can appear suddenly, and is characterized by decrease in urine output.

What is nephrotic syndrome (nephrosis)?

Nephrotic syndrome (sometimes called nephrosis) is a term used to describe a condition where there is heavy loss of protein in the urine, usually in association with a low protein level in the blood, an increase in the blood cholesterol level, and the retention of fluid (edema). Nephrotic syndrome can be a primary kidney disease or a complication of a systemic illness.

What are the symptoms and signs of acute glomerulonephritis?

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

What causes acute glomerulonephritis?

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 and signs of chronic glomerulonephritis?

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 causes chronic glomerulonephritis?

There are many causes for the general term of chronic glomerulonephritis. A wide variety of diseases affecting the glomerulus (the filtering unit of the kidney) have a common picture. There is usually a prolonged course, often with years of no symptoms, while progressive scarring of the kidney is silently occurring. Occasionally, an acute glomerulonephritis can have a quiet phase after the original illness and appear many years later as chronic glomerulonephritis. Many different causes of nephrotic syndrome can sometimes lead to the damaging process of chronic glomerulonephritis, especially when the nephrotic syndrome does not respond to treatment.

How is a diagnosis of glomerulonephritis made?

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.

Can glomerulonephritis be prevented?

It is not possible to prevent acute glomerulonephritis except with good skin hygiene. Keeping the skin clean will decrease the chances of getting a potentially serious skin infection. There is no good way to prevent getting strep throat. Antibodies will not prevent acute glomerulonephritis, even when used quickly to treat documented infection. Since chronic glomerulonephritis represents a wide variety of diseases, there is no way to prevent getting the disease.

What treatment is available for nephrotic syndrome?

In some forms of nephrotic syndrome, treatment with medicines such as corticosteroids will significantly reduce the amount of protein lost in the urine. In other types of nephrotic syndrome, corticosteriods have not been shown to help. In these cases, treatment consists of diuretics to control swelling and high blood pressure.

What treatment is available for glomerulonephritis?

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.

What else do I need to know?

Your National Kidney Foundation Affiliate can provide you with additional information regarding the different types of treatment available to people whose kidneys have failed due to disease. Many patients who experience end stage renal failure do resume their normal lifestyle after medically adjusting to their treatment. There are many resources available to help kidney patients. Your National Kidney Foundation Affiliate will acquaint you with the services and programs available in your community.