Glomerulonephritis

Answer 1

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 nephritisor 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
• Complementlevels

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.

Answer 2

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 problems with the body's immune system. Often, the exact cause of glomerulonephritis is unknown.

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

The condition may develop quickly and kidney function is lost within weeks or months (called rapidly progressive glomerulonephritis).

A quarter of people with chronic glomerulonephritis have no history of kidney disease.

The following may increase your risk of this condition:

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

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

• Amyloidosis
• Anti-glomerular basement membrane antibody disease
• Blood vessel diseases such as vasculitis or polyarteritis
• Focal segmental glomerulosclerosis
• Goodpasture syndrome
• Heavy use of pain relievers, especially NSAIDs
• Henoch-Schonlein purpura
• IgA nephropathy
• Lupus nephritis
• Membranoproliferative GN

Symptoms

Common symptoms of glomerulonephritis are:

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

Symptoms may also include the following:

• Abdominal pain
• Blood in the vomit or stools
• Cough and shortness of breath
• Diarrhea
• Excessive urination
• Fever
• General ill feeling, fatigue, and loss of appetite
• Joint or muscle aches
• Nosebleed

The symptoms of chronic kidney disease may develop over time.

Chronic renal failure symptoms may gradually develop.

Signs and tests

Because symptoms may develop slowly, the disorder may be discovered when you have an abnormal urinalysis during a routine physical or examination for another condition.

Signs of glomerulonephritis can include:

• Anemia
• High blood pressure
• Signs of reduced kidney function

A kidney biopsyconfirms the diagnosis.

Later, signs of chronic kidney disease may be seen, including:

• Nerve inflammation (polyneuropathy)
• Signs of fluid overload, including abnormal heart and lung sounds
• Swelling (edema)

Imaging tests that may be done include:

• Abdominal CT scan
• Kidney ultrasound
• Chest x-ray
• Intravenous pyelogram (IVP)

Urinalysis and other urine tests include:

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

This disease may also cause abnormal results on the following blood tests:

• Albumin
• Anti-glomerular basement membrane antibody test
• Anti-neutrophil cytoplasmic antibodies (ANCAs)
• Anti-nuclear antibodies
• BUN and creatinine
• Complementlevels

Treatment

Treatment depends on the cause of the disorder, and the type and severity of symptoms. High blood pressure may be hard to control. Controlling high blood pressure is usually the most important part of treatment.

Medicines that may be prescribed include:

• Blood pressure medications to control high blood pressure, most commonly angiotensin-converting enzyme inhibitors and angiotensin receptor blockers
• Corticosteroids
• Medications that suppress the immune system

A procedure called plasmapheresis may sometimes be used for glomerulonephritis caused by immune problems. The fluid part of the blood that contains antibodies is removed and replaced with intravenous fluids or donated plasma (that does not contain antibodies). Removing antibodies may reduce inflammation in the kidney tissues.

You may need to limit salt, fluids, protein, and other substances.

Persons with this condition should be closely watched for signs of kidney failure. Dialysis or a kidney transplant may eventually be needed.

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 temporary and reversible, or it may get worse. Progressive glomerulonephritis may lead to:

• Chronic kidney failure
• Reduced kidney function
• End-stage kidney disease

If you have nephrotic syndrome and it can be controlled, you may also be able to control other symptoms. If it cannot be controlled, you may develop end-stage kidney disease.

Complications

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

Calling your health care provider

Call your health care provider if:

• You have a condition that increases your risk of glomerulonephritis
• You develop symptoms of glomerulonephritis

Prevention

There is no 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

Appel GB. Glomerular disorders and nephrotic syndromes. In: Goldman L, Ausiello D, eds. Cecil Medicine. 23rd ed. Philadelphia, Pa: Saunders Elsevier; 2007:chap 122.

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.

Reviewed By

Review Date: 09/20/2011

David C. Dugdale, III, MD, Professor of Medicine, Division of General Medicine, Department of Medicine, University of Washington School of Medicine; and Herbert Y. Lin, MD, PhD, Nephrologist, Massachusetts General Hospital; Associate Professor of Medicine, Harvard Medical School. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.