Glomerulonephritis (Bright's Disease)

The causes of GN depend on whether it’s acute or chronic.

Acute GN

Acute GN can be a response to an infection such as strep throat or an abscessed tooth. It may be due to problems with your immune system overreacting to the infection. This can go away without treatment. If it doesn’t go away, prompt treatment is necessary to prevent long-term damage to your kidneys.

Certain illnesses are known to trigger acute GN, including:

• strep throat
• systemic lupus erythematosus, which is also called lupus
• Goodpasture syndrome, a rare autoimmune disease in which antibodies attack your kidneys and lungs
• amyloidosis, which occurs when abnormal proteins that can cause harm build up in your organs and tissues
• granulomatosis with polyangiitis (formerly known as Wegener’s granulomatosis), a rare disease that causes inflammation of the blood vessels
• polyarteritis nodosa, a disease in which cells attack arteries

Heavy use of nonsteroidal anti-inflammatory drugs, such as ibuprofen (Advil) and naproxen (Aleve), may also be a risk factor. You shouldn’t exceed the dosage and length of treatment listed on the bottle without seeking advice from your primary care provider.

Chronic GN

The chronic form of GN can develop over several years with no or very few symptoms. This can cause irreversible damage to your kidneys and ultimately lead to complete kidney failure.

Chronic GN doesn’t always have a clear cause. A genetic disease can sometimes cause chronic GN. Hereditary nephritis occurs in young men with poor vision and poor hearing. Other possible causes include:

• certain immune diseases
• a history of cancer
• exposure to some hydrocarbon solvents

As well, having the acute form of GN may make you more likely to develop chronic GN later on.

Symptoms you may experience depend on what form of GN you have as well as how severe it is.

Acute GN

Early symptoms of acute GN include:

• puffiness in your face
• urinating less often
• blood in your urine, which turns your urine a dark rust color
• extra fluid in your lungs, causing coughing
• high blood pressure

Chronic GN

The chronic form of GN can creep up without any symptoms. There may be slow development of symptoms similar to the acute form. Some symptoms include:

• blood or excess protein in your urine, which may be microscopic and show up in urine tests
• high blood pressure
• swelling in your ankles and face
• frequent nighttime urination
• bubbly or foamy urine, from excess protein
• abdominal pain
• frequent nosebleeds

Kidney failure

Your GN may be so advanced that you develop kidney failure. Some of the symptoms of this include:

• fatigue
• lack of appetite
• nausea and vomiting
• insomnia
• dry, itchy skin
• muscle cramps at night

The first step in diagnosis is a urinalysis test. Blood and protein in urine are important markers for the disease. A routine physical exam for another condition can also lead to the discovery of GN.

More urine testing may be necessary to check for important signs of kidney health, including:

• creatinine clearance
• total protein in the urine
• urine concentration
• urine specific gravity
• urine red blood cells
• urine osmolality

Blood tests may show:

• anemia, which is a low level of red blood cells
• abnormal albumin levels
• abnormal blood urea nitrogen
• high creatinine levels

Your doctor may also order immunology testing to check for:

• antiglomerular basement membrane antibodies
• antineutrophil cytoplasmic antibodies
• antinuclear antibodies
• complement levels

Results of this testing may show your immune system is damaging your kidneys.

A biopsy of your kidneys may be necessary to confirm the diagnosis. This involves analyzing a small sample of kidney tissue taken by a needle.

To learn more about your condition, you may also have imaging tests such as the following:

• CT scan
• kidney ultrasound
• chest X-ray
• intravenous pyelogram

Treatment options depend on the type of GN you’re experiencing and its cause.

One treatment is to control high blood pressure, especially if that’s the underlying cause of the GN. Blood pressure may be very hard to control when your kidneys aren’t working properly. If this is the case, your doctor may prescribe blood pressure medications, including angiotensin-converting enzyme inhibitors, or ACE inhibitors, such as:

• captopril
• lisinopril (Zestril)
• perindopril (Aceon)

Your doctor may also prescribe angiotensin receptor blockers, or ARBs, such as:

• losartan (Cozaar)
• irbesartan (Avapro)
• valsartan (Diovan)

Corticosteroids may also be used if your immune system is attacking your kidneys. They reduce the immune response.

Another method to reduce immune-triggered inflammation is plasmapheresis. This process removes the fluid part of your blood, called plasma, and replaces it with intravenous fluids or donated plasma that contains no antibodies.

For chronic GN, you’ll need to reduce the amount of protein, salt, and potassium in your diet. Additionally, you must watch how much liquid you drink. Calcium supplements may be recommended, and you may need to take diuretics to reduce swelling. Check with your general practitioner or kidney specialist for guidelines about diet restrictions or supplements. They can set you up with a medical dietician to advise you on your choices.

If your condition becomes advanced and you develop kidney failure, you may need to have dialysis. In this procedure, a machine filters your blood. Eventually, you may need a kidney transplant.

GN can lead to nephrotic syndrome, which causes you to lose large amounts of protein in your urine. This leads to a lot of fluid and salt retention in your body. You can develop high blood pressure, high cholesterol, and swelling throughout your body. Corticosteroids treat this condition. Eventually, nephrotic syndrome will lead to end-stage renal disease if it doesn’t come under control.

The following conditions can also occur due to GN:

• acute kidney failure
• chronic kidney disease
• electrolyte imbalances, such as high levels of sodium or potassium
• chronic urinary tract infections
• congestive heart failure due to retained fluid or fluid overload
• pulmonary edema due to retained fluid or fluid overload
• high blood pressure
• malignant hypertension, which is rapidly increasing high blood pressure
• increased risk of infections

If caught early, acute GN can be temporary and reversible. Chronic GN may be slowed with early treatment. If your GN worsens, it will likely lead to reduced kidney function, chronic kidney failure, and end-stage renal disease.

Severe kidney damage, kidney failure, and end-stage renal disease may eventually require dialysis and a kidney transplant.

The following are positive steps to recover from GN and prevent future episodes:

• Maintain a healthy weight.
• Restrict salt in your diet.
• Restrict protein in your diet.
• Restrict potassium in your diet.
• Quit smoking.

In addition, meeting with a support group can be a helpful way for you to deal with the emotional stress of having a kidney disease.