Glomerulonephritis
What is Glomerulonephritis?
Glomerulonephritis is a group of diseases that cause inflammation of the glomeruli, the tiny filtering units in the kidneys. The glomeruli help filter waste and excess fluids from the blood, which are then excreted as urine. When these filters become inflamed, they cannot function properly, leading to a range of kidney problems, including hematuria (blood in the urine), proteinuria (protein in the urine), and sometimes kidney failure.
There are two main types of glomerulonephritis:
1. Acute Glomerulonephritis: A sudden onset of kidney inflammation, often triggered by infections or an immune response.
2. Chronic Glomerulonephritis: A slow, progressive inflammation of the kidneys that may lead to long-term kidney damage and chronic kidney disease (CKD).
Causes of Glomerulonephritis:
1. Infections:
- Post-Streptococcal Glomerulonephritis: Often follows a strep throat or skin infection caused by Streptococcus bacteria.
- Bacterial Endocarditis: Infection of the heart valves may trigger glomerulonephritis.
- Hepatitis B and C: Chronic infections with these viruses can lead to inflammation in the kidneys.
2. Autoimmune Diseases:
- Lupus Nephritis: Lupus, an autoimmune disease, can cause immune complexes to deposit in the kidneys, leading to glomerulonephritis.
- IgA Nephropathy (Berger’s Disease): The immune system produces antibodies (IgA) that get lodged in the kidneys, causing inflammation.
- Goodpasture Syndrome: An autoimmune condition where the immune system attacks both the kidneys and lungs.
3. Vasculitis: Inflammation of blood vessels (as seen in conditions like polyarteritis nodosa or granulomatosis with polyangiitis) can affect the kidneys and lead to glomerulonephritis.
4. Other Causes:
- Membranoproliferative Glomerulonephritis (MPGN): Can be associated with certain infections or immune system diseases.
- Minimal Change Disease: Often causes nephrotic syndrome, more common in children.
Symptoms:
- Hematuria: Blood in the urine, often giving it a tea, cola, or red tint.
- Proteinuria: Excess protein in the urine, which may make the urine appear foamy.
- Edema (Swelling): Particularly in the face, hands, feet, and abdomen due to fluid retention.
- Hypertension (High Blood Pressure): The inflammation can cause the kidneys to retain sodium, leading to high blood pressure.
- Oliguria: Decreased urine output, indicating impaired kidney function.
- Fatigue: Resulting from the buildup of waste products in the blood (uremia).
- Flank or Abdominal Pain: Pain in the lower back or sides, especially if kidney swelling occurs.
- Fever: In some cases, particularly with acute post-infectious glomerulonephritis.
Diagnosis:
1. Urinalysis: To detect the presence of blood, protein, or other abnormalities in the urine.
2. Blood Tests:
- Creatinine and Blood Urea Nitrogen (BUN): To assess kidney function.
- Anti-Streptolysin O (ASO) Titer: To check for recent streptococcal infections.
- Complement Levels (C3 and C4): Low levels may indicate immune system involvement.
3. Imaging Tests:
- Ultrasound or CT Scan: To visualize the kidneys and detect structural abnormalities.
4. Kidney Biopsy: A small sample of kidney tissue is taken for microscopic examination to confirm the diagnosis and determine the cause of glomerulonephritis.
Treatment:
The treatment depends on the underlying cause, the severity of kidney damage, and whether the disease is acute or chronic.
1. Medications:
- Corticosteroids: To reduce inflammation in cases of autoimmune glomerulonephritis.
- Immunosuppressants: Drugs like cyclophosphamide or azathioprine may be used in autoimmune conditions or severe cases to suppress the immune response.
- Antibiotics: For infections like post-streptococcal glomerulonephritis.
- Blood Pressure Medications: ACE inhibitors or ARBs can help control high blood pressure and reduce proteinuria.
- Diuretics: To reduce fluid retention and swelling.
2. Dietary Changes:
- Low Sodium: To help control blood pressure and reduce fluid retention.
- Protein Restriction: In cases of severe kidney dysfunction, limiting protein intake may reduce the workload on the kidneys.
- Low Potassium and Phosphorus: If kidney function is impaired, managing these electrolytes may be necessary.
3. Plasmapheresis: In conditions like Goodpasture syndrome or certain rapidly progressive glomerulonephritis cases, this procedure filters harmful antibodies from the blood.
4. Dialysis: In severe cases of kidney failure, dialysis may be required to filter waste from the blood.
5. Kidney Transplant: In chronic or end-stage kidney disease due to glomerulonephritis, a kidney transplant may be necessary.
Complications:
1. Chronic Kidney Disease (CKD): Long-term glomerulonephritis can lead to progressive loss of kidney function.
2. Acute Kidney Failure: Rapidly progressive forms of glomerulonephritis can cause the kidneys to suddenly stop functioning.
3. Nephrotic Syndrome: A condition characterized by high levels of protein in the urine, low levels of protein in the blood, high cholesterol, and swelling.
4. Hypertension: Poorly controlled blood pressure can further damage the kidneys and cardiovascular system.
5. Fluid Overload: Can lead to congestive heart failure if excess fluid accumulates in the body.
6. Electrolyte Imbalances: May occur due to impaired kidney function.
Prognosis:
The outlook for glomerulonephritis varies depending on the cause, severity, and how quickly treatment is initiated. Acute cases, especially those triggered by infections, often resolve with treatment. Chronic or severe cases may lead to progressive kidney damage and eventually kidney failure, requiring long-term management or kidney replacement therapy (dialysis or transplant).
Early diagnosis and treatment are crucial to prevent long-term kidney damage and preserve kidney function.
