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Glomerulonephritis

Definition

Glomerulonephritis is a type of kidney disease caused by inflammation of the internal kidney structures (glomeruli).

Causes

Glomerulonephritis may be a temporary and reversible condition, or it may get worse. Progressive glomerulonephritis may result in destruction of the kidney glomeruli and chronic renal failure and end stage renal disease. The disease may be caused by specific problems with the body's immune system, but the precise cause of some cases is unknown.

Damage to the glomeruli with subsequent impaired filtering causes blood and protein to be lost in the urine. Because symptoms develop gradually, the disorder may be discovered when there is an abnormal urinalysis during routine physical or examination for unrelated disorders. Glomerulonephritis can cause hypertension (high blood pressure) and may only be discovered as a cause of high blood pressure that is difficult to control.

It may develop after survival of the acute phase of rapidly progressive glomerulonephritis. In about a quarter of people with chronic glomerulonephritis there is no prior history of kidney disease and the disorder first appears as chronic renal failure.

Specific disorders that are associated with glomerulonephritis include:

• Focal segmental glomerulosclerosis (FSG)
• Goodpasture's syndrome
• IgA nephropathy
• Lupus nephritis
• Membranoproliferative GN I
• Membranoproliferative GN II
• Post-streptococcal GN
• Rapidly progressive (crescentic) glomerulonephritis
• Rapidly progressive glomerulonephritis (RPGN)

Symptoms

• Blood in the urine (dark, rust-colored, or brown urine)
• Foamy urine

Chronic renal failure symptoms that may gradually develop include the following:

• Unintentional weight loss
• Nausea, vomiting
• General ill feeling (malaise)
• Fatigue
• Headache
• Frequent hiccups
• Generalized itching
• Decreased urine output
• Need to urinate at night
• Easy bruising or bleeding
• Decreased alertness
  • Drowsiness, somnolence, lethargy
  • Confusion, delirium
  • Coma
• Muscle twitching
• Muscle cramps
• Seizures
• Increased skin pigmentation (hyperpigmentation) -- skin may appear yellow or brown
• Decreased sensation in the hands, feet, or other areas

Additional symptoms that may be associated with this disease:

• Excessive urination
• Nosebleed
• High blood pressure
• Blood in the vomit or in stools

Exams and Tests

High blood pressure may be present along with abnormal urinalysis  Laboratory tests may reveal anemia or indicate reduced kidney functioning, including azotemia (accumulation of nitrogenous wastes such as creatinine and urea). Later, signs of chronic renal failure may be apparent, including edema (swelling), polyneuropathy, and signs of fluid overload including abnormal heart and lung sounds.

• A urinalysis may show blood, casts  protein, or some other abnormality.
• Findings on kidney or abdominal ultrasound  kidney or abdominal CT scan, or IVP are non-specific.
• A chest x-ray may show fluid overload.
• A kidney biopsy may show one of the forms of chronic glomerulonephritis or non specific scarring of the glomeruli.

• Urine specific gravity
• Urine concentration test
• Uric acid, urine
• Total protein
• Urine RBC
• Urine protein
• Creatinine clearance
• Urine creatinine
• Complement component 3
• Complement
• BUN
• Anti-glomerular basement membrane
• Albumin

Treatment

Treatment varies depending on the cause of the disorder, and the type and severity of symptoms. The primary treatment goal is control of symptoms. High blood pressure may be difficult to control, and it is generally the most important aspect of treatment.

Various antihypertensive medications may be used to attempt to control high blood pressure. Corticosteroids, immunosuppressives, or other medications may be used to treat some of the causes of chronic glomerulonephritis

Dietary restrictions on salt, fluids, protein, and other substances may be recommended to aid control of hypertension or kidney failure.

Dialysis or kidney transplantation may be necessary to control symptoms of renal failure and to sustain life.

Support Groups

The stress of illness can often be helped by joining support groups where members share common experiences and problems. See kidney disease - support group.

Outlook (Prognosis)

The outcome varies depending on the cause. Some types of glomerulonephritis may have spontaneous remission.

If nephrotic syndrome is present and can be controlled, other symptoms may be controlled. If nephrotic syndrome is present and cannot be controlled, end-stage renal disease may result.

The disorder gets worse at widely variable rates.

Possible Complications

• Nephrotic syndrome
• Acute nephritic syndrome
• Chronic renal failure
• End-stage renal disease
• Hypertension
• Malignant hypertension
• Fluid overload -- congestive heart failure, pulmonary edema
• Chronic or recurrent urinary tract infection
• Increased susceptibility to other infections

When to Contact a Medical Professional

Call your health care provider if disorders associated with increased risk of glomerulonephritis are present, or if symptoms indicating glomerulonephritis develop.

Prevention

There is no specific prevention for most cases of glomerulonephritis. Some cases may be prevented by avoiding or limiting exposure to organic solvents, mercury, and nonsteroidal anti-inflammatory analgesics.