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Glomerulonephritis

Overview

Glomerulonephritis is a condition in which there is an inflammation of the glomeruli of the kidneys. Glomeruli are tufts of small blood vessels that filter the waste materials from the blood and produce urine. It results from an immunological reaction that may occur after an infection with bacteria and viruses or as a part of other inflammatory diseases. It may go unnoticed or may cause blood or protein to appear in your urine. In some people, it may cause high blood pressure, while in 30% of people, it may progress to end-stage renal disease. 

Causes

The causes of GN can be broadly divided into two categories.

1.       Infectious: Most commonly, the GN results after an infection is by streptococcus bacteria. Other agents may include; some bacteria, like; Staphylococci, Diplococci, Mycobacteria, Salmonella typhosa, etc. It can also result after infection with viruses that include; Cytomegalovirus (CMV), Epstein-Barr virus (EBV), coxsackievirus, parvovirus B19, mumps, hepatitis B, etc. Some parasites have also been found to be the culprit, including Plasmodium malariae, Plasmodium falciparum, Schistosoma mansoni, Toxoplasma gondii, etc.

2.       Non-infectious: GN can be a part of other inflammatory conditions that affect kidneys or some systemic diseases. These include;

·         Membranoproliferative glomerulonephritis (MPGN)

·         Immunoglobulin A (IgA) nephropathy (Berger disease) -

·          Rapidly progressive glomerulonephritis

·         Wegener granulomatosis

·         Systemic lupus erythematosus [SLE)

·         Hypersensitivity vasculitis

·         Henoch-Schönlein purpura

·         Polyarteritis nodosa

·         Goodpasture syndrome

·         Guillain-Barré syndrome

Epidemiology

Glomerulonephritis is among 10-15% of the conditions that affect the glomeruli of the kidneys. The most common cause of GN worldwide is IgA Nephropathy, also known as Berger disease. The incidence of post-infectious GN (the one occurring after infections) has declined in developed countries. It mainly affects people between the ages of 5 and 15 years. 

Risk Factors

The following risk factors can increase your chances of getting GN;

·         Genetics- family history

·         Having a co-morbid condition like hypertension(high blood pressure), Diabetes mellitus

·         Smoking

·         Having a systemic inflammatory illness

·         Suffering from any bacterial, viral or parasitic infection that has not been treated properly

Signs And Symptoms

Initially, the GN does not exhibit itself prominently. It is often found incidentally on routine blood tests. However, you may have the following signs and symptoms;

·         Hematuria: Your urine may appear pink or cola-colored due to the presence of red blood cells in it.

·         Proteinuria: Your urine may appear frothy or foamy due to the presence of proteins in it.

·         Hypertension: High blood pressure

·         Edema: your body may retain water resulting in the swelling of the face, feet, and abdomen

·         Nausea and vomiting

·         You may have muscle cramps

·         You may feel unusually tired

·         Low appetite

·         Change in urine frequency

Diagnosis

Diagnosis is made based on history, focusing on previous and current diseases or infections, followed by physical examination and laboratory analysis of blood and urine.

  • Blood tests: They can reveal an infection, low quantities of albumin, and a lower blood protein concentration altogether. The amounts of blood urea nitrogen and electrolytes in your blood may also be examined to determine how well your kidneys are working. Some other important parameters can also be checked, like ESR, complement levels, and blood culture.
  • Urinalysis: It can show proteinuria, RBC casts, WBC casts, and pyuria.
  • 24 hrs urine collection: You will need to obtain a urine specimen over 24 hours. After that, your medical practitioner will submit the specimens to a laboratory for examination.
  • Imaging studies: a CT scan or Ultrasound of the kidneys may show abnormalities in the kidneys.
  • Biopsy; In kidney biopsy, a tiny piece of kidney tissue may be removed for examination by your physician. A needle is pushed into your dermis and then to your kidney, and a small piece of tissue is taken and submitted to a laboratory for analysis.

Differential Diagnosis

Other disorders that may need to be evaluated include;

  • Acute Kidney Injury
  • Idiopathic hematuria
  • Irradiation of Wilms tumor
  • Drug toxicity
  • HIV-Related Renal Disorders
  • IgA Nephropathy
  • Light Chain-Associated Renal Disorders
  • Radiation Nephropathy
  • Sickle Cell Nephropathy
  • Transplant glomerulopathy
  • Transplant Rejection

Treatment

If you notice the symptoms of GN, you should consult your healthcare provider. The type and cause of glomerulonephritis determine the course of treatment. The treatment goals are to identify the root cause, control the symptoms with medications, and halt the progression toward chronic GN and end-stage kidney disease.

Prompt use of antibiotics within 36 hours of infections can help prevent the development of post-infectious GN. Once acute GN develops, only supportive treatment can be given. Sometimes it resolves on its own.

Supportive treatment includes;

Limiting the intake of salt, potassium, and protein: You may be advised to decrease your intake of salts, proteins, and potassium.

Treating high blood pressure: ACE inhibitors are the best strategy for controlling blood pressure as they also decrease the quantity of protein excreted in the urine. Lisinopril, captopril, and enalapril are examples of medicines in this group. ARBs, which include losartan and valsartan, are another class of medications that function in a comparable pattern.

Water content controlling pills. These increase the fluid production from your kidneys, which helps to decrease edema. Furosemide is a common diuretic medicine (Lasix). Spironolactone and thiazides (hydrochlorothiazide, metolazone) are two others.

Medications to suppress the immune system: Sometimes, your physician might advise these drugs to lower inflammation in your body due to autoimmune or systemic diseases. They include corticosteroids, rituximab, and cyclophosphamide.

Plasmapheresis: It is a special process that can extract harmful substances, including antibodies, away from your blood. 

Prognosis

Most cases of acute GN end in complete patient recovery. 0-7% mortality has been reported in pediatric patients. Some cases may progress to chronic GN. Rarely, it may lead to kidney failure, resulting in the accumulation of harmful products that need to be removed immediately using dialysis. Dialysis is an unnatural method of eliminating excess liquids and toxins from your blood that is usually performed using a kidney dialysis machine.

Lifestyle Modifications

Certain factors linked with glomerulonephritis are unavoidable. However, you may take measures to protect your kidneys.

  • If you have hypertension or diabetes, start taking medications for it.
  • Eat healthy meals and drink plenty of water to keep your kidneys healthy.
  • Get vaccinated for contagious diseases, mainly if you deal with people who have hepatitis or some other conditions.
  • Perform mild exercises regularly to keep you active.
  • Avoid smoking
  • Whenever your physician recommends antibiotics, follow the directions carefully and finish the complete course, even though you begin to feel well.

Our clinical experts continually monitor the health and medical content posted on CURA4U, and we update our blogs and articles when new information becomes available. Last reviewed by Dr.Saad Zia on May 02, 2023.

References

https://www.kidney.org/atoz/content/glomerul

https://www.nhs.uk/conditions/glomerulonephritis/#:~:text=Glomerulonephritis%20is%20damage%20to%20the,usually%20cause%20any%20noticeable%20symptoms.

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