Glomerulonephritis

In this condition factsheet:

• The Facts
• Causes
• Symptoms and Complications
• Making the Diagnosis
• Treatment and Prevention

The Facts

Glomerulonephritis is a progressive kidney disease that involves the glomeruli, the individual filtering units of the kidney that produce urine. When the glomeruli become inflamed, the kidneys can't filter urine properly. This results in a buildup of excess fluid and toxins in the body. Glomerulonephritis can lead to chronic renal (kidney) failure.

There are 2 main types of glomerulonephritis: primary and secondary. Primary glomerulonephritis affects the kidneys directly, while in secondary glomerulonephritis the kidneys are damaged as a result of another illness. Glomerulonephritis seems to happen twice as often in males as in females.

Causes

Most people with glomerulonephritis have no known cause or risk factors.

The most common known causes are bacterial (most often streptococcal) and viral infections. Doctors have found that many children with glomerulonephritis had been diagnosed with a streptococcal infection, such as strep throat, not long before developing signs of kidney damage. People with hepatitis or HIV/AIDS can also develop glomerulonephritis.

People with autoimmune disorders, such as lupus, also seem to be at risk of developing glomerulonephritis. The immune system, instead of attacking bacteria or viruses, attacks the kidneys so that they can't function properly.

Glomerulonephritis may also be hereditary or, in rare instances, may be caused by medications.

Symptoms and Complications

The kidneys play three major roles in regulating the body. They:

• filter urine to remove waste from the body, keeping toxins from building up in the bloodstream
• regulate the minerals or electrolytes (sodium, calcium, and potassium, for example) and the levels of fluid in the body
• produce hormones that control other body functions, such as blood pressure, bone maintenance, and red blood cell production

Because of the large role the kidneys play in maintaining the body's health, the symptoms of glomerulonephritis and kidney failure are quite varied. Symptoms of glomerulonephritis include:

• blood in the urine
• excessive foaming of the urine
• increased urination

Chronic renal (kidney) failure may develop. Symptoms are a direct result of the kidneys' inability to eliminate waste and excess fluid from the body. When kidney failure is severe or near end stage, symptoms include:

• confusion
• decreased urination
• fatigue
• headache
• high blood pressure
• itchy skin
• loss of appetite
• muscle twitching or cramping
• nausea and vomiting
• nosebleeds
• puffy eyes, hands, and feet (called edema)
• shortness of breath
• thirst
• weight loss
• a yellowish-brown tint to the skin

The symptoms can become more severe if the inflammation isn't treated and kidney damage gets worse. Seizures and coma are possible in the later stages.

Glomerulonephritis is serious. If left untreated, glomerulonephritis can lead to chronic renal failure, end-stage renal disease, high blood pressure, congestive heart failure, pulmonary edema, and an increased risk of other infections, especially urinary tract and kidney infections.

Making the Diagnosis

Kidney damage is slow and progressive, so it's not usually obvious at first. Unfortunately, a lot of damage can be done before any symptoms become noticeable, and sometimes it's only picked up during routine blood or urine testing.

If glomerulonephritis is suspected, your doctor will review your medical history. The history is followed by a physical exam and any of the following tests might be ordered:

• blood tests
• urine tests
• kidney or abdominal ultrasounds
• kidney or abdominal CT (computed tomography) scans
• an IVP (intravenous pyelogram) - an X-ray examination of the kidneys, ureters, and bladder
• chest X-rays (if heart failure is suspected)
• a kidney biopsy

The blood tests show any buildup of body wastes in the bloodstream (such as urea), while urine tests reveal elements that shouldn't be present, such as protein or red blood cells. Ultrasounds and scans show kidney size (kidneys become enlarged in glomerulonephritis) and anything unusual, such as tumours or blockages.

Finally, a kidney biopsy might be performed to confirm the diagnosis. In a biopsy, they insert a fine needle into the kidney, using an ultrasound as a guide; with the needle, they take a tiny tissue sample, which they then check under a microscope for damage or disease.

Treatment and Prevention

Treatment of glomerulonephritis varies greatly from person to person, depending on whether it's acute or chronic and on how much damage has been done to the kidneys.

For acute glomerulonephritis, the first goal is to reduce the symptoms and try to prevent more kidney damage. If high blood pressure (hypertension) has developed, it will be treated with anti-hypertensive medications (medications to lower blood pressure).

If the condition is due to a bacterial infection, antibiotics will be prescribed. It's very important to take antibiotics exactly as instructed for the full course of treatment, even if the symptoms of infection disappear after a few days of treatment. This is to make sure that the infection is truly gone. Viral infections can't be treated by antibiotics and must run their course.

Corticosteroids and medications to suppress the immune system may also be used to treat glomerulonephritis.

Your doctor might also prescribe a diuretic. Diuretics increase the body's urine output, causing you to urinate larger amounts more frequently. These medications are often referred to as "water pills." It's usually best to take diuretics in the morning or early afternoon to avoid having to get up often during the night to urinate.

Vitamin or mineral supplements may be recommended, depending on the results of the blood tests, to help keep the levels of electrolytes (e.g., sodium, calcium, and potassium) balanced. People with kidney problems might be advised to change to a diet that cuts down on the waste buildup in the bloodstream. These diets aren't usually needed if the kidney damage is mild.

The prognosis of glomerulonephritis depends on whether it's an acute, first-time episode or whether it's chronic. The cause of the inflammation is another important factor. If the inflammation is treated early, and the cause is treatable, and the kidney damage is minor, the prognosis is good.

In severe cases of glomerulonephritis, however, kidney damage can get worse, leading to chronic renal failure and other associated problems such as hypertension and heart failure. In severe cases, dialysis may be needed.

Dialysis isn't a cure, and people who are on dialysis must follow special diets, restrict fluids, and take medications as prescribed by their doctors. The type of dialysis performed - peritoneal dialysis or hemodialysis - is chosen by the health care team according to individual needs. Dialysis removes excess fluids and waste using a membrane, instead of a kidney, as a filter.
If need be, your health care team will assess you for a kidney transplant. As frightening as this may be, kidney transplants are relatively common now and have a good success rate. Someone who has had a successful transplant can go on to live a normal, healthy life.

Glomerulonephritis can't really be anticipated, but doctors may be able to prevent some of the problems associated with the kidney damage if it's caught early enough.
If you have known risk factors for kidney failure, such as lupus, make sure you are aware of what signs and symptoms to watch for. Take any infections seriously and get treatment for them. If antibiotics are prescribed, take them as directed and for the full length of treatment.

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