Glomerulonephritis

Definition

Glomerulonephritis is a type of kidney disease in which the part of your kidneys that helps filter waste and fluids from the blood is damaged.

Alternative Names

Glomerulonephritis - chronic; Chronic nephritis; Glomerular disease; Necrotizing glomerulonephritis; Glomerulonephritis - crescentic; Crescentic glomerulonephritis; Rapidly progressive glomerulonephritis

Causes, incidence, and risk factors

Glomerulonephritis may be caused by specific problems with the body's immune system. Often, the precise cause of glomerulonephritis is unknown.

Damage to the glomeruli causes blood and protein to be lost in the urine.

The condition may develop quickly, with loss of kidney function occurring over weeks and months (called rapidly progressive glomerulonephritis).

In about a quarter of people with chronic glomerulonephritis there is no history of kidney disease and the disorder first appears as chronic renal failure.

The following increase your risk of developing this condition:

• History of cancer
• Blood or lymphatic system disorders
• Exposure to hydrocarbon solvents
• Infections such as strep infections, viruses, heart infections,or abscesses
• Diabetes

Many conditions are known to cause or increase the risk for glomerulonephritis, including:

• Focal segmental glomerulosclerosis
• Goodpasture syndrome
• Membranoproliferative GN
• IgA nephropathy
• Lupus nephritis or Henoch-Schonlein purpura
• Anti-glomerular basement membrane antibody disease
• Blood vessel diseases such as vasculitis or polyarteritis
• Amyloidosis

Symptoms

Common symptoms of glomerulonephritis are:

• Blood in the urine (dark, rust-colored, or brown urine)
• Foamy urine
• Swelling (edema) of the face, eyes, ankles, feet, legs, or abdomen

Symptoms that may also appear include the following:

• Abdominal pain
• Cough
• Diarrhea
• General ill feeling
• Fever
• Joint aches
• Muscle aches
• Loss of appetite
• Shortness of breath

Chronic renal failure symptoms may gradually develop.

Other symptoms that may occur with this disease:

• Excessive urination
• Nosebleed
• Blood in the vomit or in stools

Signs and tests

Because symptoms develop gradually, the disorder may be discovered when there is an abnormal urinalysis during a routine physical or examination for unrelated disorders.

Glomerulonephritis can cause high blood pressure. It may only be discovered as a cause of high blood pressure that is difficult to control.

Laboratory tests may reveal anemia or show signs of reduced kidney functioning. A kidney biopsy confirms the diagnosis.

Later, signs of chronic kidney failure may be seen, including swelling (edema), polyneuropathy, and signs of fluid overload, including abnormal heart and lung sounds.

Imaging tests that may be done include:

• Abdominal CT scan
• Abdominal ultrasound
• Chest x-ray
• IVP

Urinalysis and other urine tests include:

• Examination of the urine under a microscope
• Creatinine clearance
• Total protein
• Uric acid, urine
• Urine concentration test
• Urine creatinine
• Urine protein
• Urine RBC
• Urine specific gravity

This disease may also affect the results of the following blood tests:

• Albumin
• Anti-glomerular basement membrane antibody test
• Anti-neutrophil cytoplasmic antibodies (ANCAs)
• BUN and creatinine
• Complement component 3
• Complement levels

Treatment

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

Medicines that may be prescribed include:

• Blood pressure medications are often needed to control high blood pressure. Angiotensin-converting enzyme inhibitors and angiotensin receptor blockers are most commonly prescribed.
• Corticosteroids may relieve symptoms in some cases.
• Medications that suppress the immune system may also be prescribed, depending on the cause of the condition.

A procedure called plasmapheresis may be used for some cases of glomerulonephritis due to immune-related causes. The fluid part of the blood containing antibodies is removed and replaced with intravenous fluids or donated plasma (without antibodies). Removing antibodies may reduce inflammation in the kidney tissues.

Dietary restrictions on salt, fluids, protein, and other substances may be recommended.

Persons with this condition should be closely watched for signs that they are developing kidney failure. Dialysis or a kidney transplant may eventually be necessary.

Support Groups

You can often ease the stress of illness by joining support groups where members share common experiences and problems.

See: Kidney disease - support group

Expectations (prognosis)

Glomerulonephritis may be a temporary and reversible condition, or it may get worse. Progressive glomerulonephritis may lead to chronic kidney failure and end-stage kidney disease.

If you have nephrotic syndrome and it can be controlled, other symptoms may also be controlled. If it can't be controlled, end-stage kidney disease may result.

Complications

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

Calling your health care provider

Call your health care provider if:

• You have disorders that are associated with an increased risk of glomerulonephritis
• You develop symptoms of glomerulonephritis

Prevention

There is no specific way to prevent most cases of glomerulonephritis. Some cases may be prevented by avoiding or limiting exposure to organic solvents, mercury, and nonsteroidal anti-inflammatory drugs (NSAIDs).

References

Nachman PH, Jennette JC, Falk RJ. Primary glomerular disease. In: Brenner BM, ed. Brenner and Rector's The Kidney. 8th ed. Philadelphia, Pa:Saunders Elsevier;2007:chap 30.

Haymart MR, Atta MG. Glomerular disease. In: Nilsson KR Jr., Piccini JP. The Osler Medical Handbook. 2nd ed. Philadelphia Pa: Saunders Elsevier;2006:chap 65.