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Glomerulonephritis

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

 

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.

Causes

 

Glomerulonephritis may be caused by problems with the body's immune system. Often, the exact cause of this condition 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. This is called rapidly progressive glomerulonephritis.

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

The following may increase your risk for 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
  • Antiglomerular 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-Schönlein 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.

 

Exams 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 biopsy confirms 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 for total 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
  • Antiglomerular basement membrane antibody test
  • Antineutrophil cytoplasmic antibodies (ANCAs)
  • Antinuclear antibodies
  • BUN and creatinine
  • Complement levels

 

Treatment

 

Treatment depends on the cause of the disorder, and the type and severity of symptoms. Controlling high blood pressure is usually the most important part of treatment.

Medicines that may be prescribed include:

  • Blood pressure drugs, most often angiotensin-converting enzyme inhibitors and angiotensin receptor blockers
  • Corticosteroids
  • Drugs 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.

People 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.

 

Outlook (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.

 

When to Contact a Medical Professional

 

Call your health care provider if:

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

 

Prevention

 

Most cases of glomerulonephritis can't be prevented. Some cases may be prevented by avoiding or limiting exposure to organic solvents, mercury, and nonsteroidal anti-inflammatory drugs (NSAIDs).

 

 

References

Appel GB, Radhakrishnan JAI, D'Agati VD. Secondary glomerular disease. In: Taal MW, Chertow GM, Marsden PA, Skorecki K, Yu ASL, Brenner BM, eds. Brenner and Rector's The Kidney. 9th ed. Philadelphia, PA: Elsevier Saunders; 2012:chap 32.

Cattran DC, Reigh HN. Overview of therapy for glomerular disease. In: Taal MW, Chertow GM, Marsden PA, Skorecki K, Yu ASL, Brenner BM, eds. Brenner and Rector's The Kidney. 9th ed. Philadelphia, PA: Elsevier Saunders; 2012:chap 33.

Nachman PH, Hennette JC, Falk RJ. Primary glomerular disease. In: Taal MW, Chertow GM, Marsden PA, Skorecki K, Yu ASL, Brenner BM, eds. Brenner and Rector's The Kidney. 9th ed. Philadelphia, PA: Elsevier Saunders; 2012:chap 31.

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  • Kidney anatomy

    Kidney anatomy

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    • Kidney anatomy

      Kidney anatomy

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    Tests for Glomerulonephritis

     
       

      Review Date: 9/22/2015

      Reviewed By: Charles Silberberg, DO, private practice specializing in nephrology, affiliated with New York Medical College, Division of Nephrology, Valhalla, NY. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.

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