Definition and Overview

The kidneys are fist-sized organs located at the back of the abdominal cavity, one on each side of the spine. They are responsible for filtering waste and extra fluid from the blood.

Each kidney has an outer renal cortex, a renal pelvis, and an internal renal medulla. Blood from the renal arteries is filtered by tiny structures called nephrons located partly on the inside of the renal pyramids and cortex. Within nephrons are small, intertwined groups of capillaries (glomeruli) that filter the blood to make urine. Inflammation of the glomeruli is referred to as glomerulonephritis.

Glomerulonephritis impairs kidney function. Unless diagnosed and treated early, it can lead to kidney failure.

Causes of Condition

Glomerulonephritis can either be acute or chronic. It can develop suddenly, usually due to certain infections, such as strep throat. Acute cases normally resolve on their own or are treated with antibiotics.

Chronic glomerulonephritis, on the other hand, is characterised by slow, cumulative damage and scarring of the glomeruli. It can be caused by viral infections (such as hepatitis B and C and acquired immunodeficiency syndrome or AIDS) or autoimmune diseases, including Goodpasture’s syndrome, lupus, Wegener’s disease, and polyarteritis nodosa. However, in many cases, the cause of the condition is unknown.

Other medical conditions linked to the development of glomerulonephritis include:

  • Bacterial endocarditis, or the inflammation of the endocardium or the inner lining of the heart

  • Vasculitis, or the inflammation of blood vessels

  • High blood pressure

  • Diabetic kidney disease - Diabetes is a metabolic disorder which can either prevent the body from making enough insulin or compromise its ability to properly use insulin. Diabetes is one of the most common causes of kidney problems.

  • Certain cancers, including lung cancer, multiple myeloma, and chronic lymphocytic leukemia

  • Amyloidosis, or the harmful build-up of protein in organs and tissues

Key Symptoms

Early symptoms of acute glomerulonephritis include infrequent urination, blood in urine (hematuria), high blood pressure, and calcium in urine (proteinuria), which makes it foamy or bubbly. When the condition progresses or becomes chronic, patients will also experience frequent nighttime urination, swelling of the face and ankles, frequent nosebleeds, and abdominal pain.

Who to See and Types of Treatments Available

Patients showing symptoms of glomerulonephritis may consult a general practitioner for initial assessment. If glomerulonephritis is suspected, the patient is referred to a nephrologist, a medical doctor who specialises in the treatment of kidney diseases. The condition is diagnosed using the following tests and procedures:

  • Urinalysis - Urinalysis can detect red blood cells (RBC), albumin, or RBC casts in urine, which are signs of damage to the glomeruli as well as renal failure. The test can also detect white blood cells (an indication of infection) and increased amount of protein (an indication of nephron damage) in urine.

  • Complete blood count (CBC) - Used to determine if the patient is anemic, which may suggest impaired erythropoietin production. Erythropoietin is a hormone produced by the kidneys that promotes the formation of red blood cells in the bone marrow.

  • Serum chemistry - Blood serum contains electrolytes, hormones, antibodies, antigens, and any exogenous substance that is not involved in blood clotting. By testing the serum, the doctor can confirm if serum creatinine and urea nitrogen levels are elevated. The test can also confirm impaired vitamin D-3 production, high levels of parathyroid hormone, and low serum albumin, which are also signs of problems with kidney function.

  • Ultrasound - An imaging test used to visualise the kidneys. It can show physical damage to the organ and structural lesions that may be causing the patient’s symptoms.

  • Renal biopsy - Involves the use of a thin needle to obtain a small amount of kidney tissue for laboratory analysis. The test helps determine the type of kidney disease the patient has, its severity, and the best course of treatment for the condition.

Treatment

Treatment of acute glomerulonephritis caused by infection is often not necessary because the condition resolves on its own in many cases. If it doesn’t, the patient is usually prescribed with antibiotics.

Chronic cases, on the other hand, require treatment that focuses on addressing underlying causes to prevent further damage to the kidneys. Depending on what triggers the condition, treatment may involve:

  • Proper management of diabetes and hypertension with medications, lifestyle modifications, and regular exercise

  • Weight reduction and bariatric surgery, if the patient is obese

  • Treatment of anemia with iron supplements and diet modifications

  • Treatment of hyperlipidemia with statins and lifestyle modifications

  • Suppression of the immune system if the condition is caused by an autoimmune disorder

  • Use of diuretics to help the kidneys expel excess sodium and water

The prognosis for patients with chronic glomerulonephritis depends on the severity of the symptoms, the person’s age, and whether or not the underlying cause, such as diabetes and hypertension, can be treated. Kidney function is generally preserved in patients who receive prompt diagnosis and treatment. If treatment occurs late, kidney failure is highly likely. This condition requires life-long dialysis or kidney transplantation. The prognosis is worse in elderly patients and if the underlying cause of glomerulonephritis is unknown.

References:

  • Kawasaki Y. Mechanism of onset and exacerbation of chronic glomerulonephritis and its treatment. Pediatr Int. 2011 Dec. 53(6):795-806.

  • Kidney failure: Choosing a treatment that’s right for you. National Institute of Diabetes and Digestive and Kidney Diseases. https://www.niddk.nih.gov/health-information/health-topics/kidney-disease/kidney-failure-choosing-a-treatment-thats-right-for-you/Pages/facts.aspx.

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