Glomerulonephritis - Causes, Symptoms, Diagnosis and Treatment

What Is Glomerulonephritis (GN)?

Glomerulonephritis is an inflammation of the glomerulus (units of the kidney). These units filter the blood by removing the waste products and excess fluid in the form of urine from the body. If the kidneys fail to do so, there will be an accumulation of waste products inside the body and a loss of protein and blood in the urine which can further lead to kidney failure. GN is a life-threatening condition and needs immediate attention. Early diagnosis and treatment prevent kidney failure. It can be acute or chronic, depending upon the cause, and is also called nephritis, nephrotic syndrome, or Bright’s disease. GN can be immune-mediated or can be a result of persistent infections. Hematuria and proteinuria can be a result of this. Fatigue and anemic conditions are the results of the loss of red blood cells (RBCs) from blood.

What Causes Glomerulonephritis?

Acute Glomerulonephritis -

• It is caused by bacterial infections such as Streptococcus species (especially group A, beta-hemolytic) and Staphylococcus aureus.

• Autoimmune immunological mechanisms trigger inflammation of renal tubules.

• Acute GN leads to the retention of toxins inside the body, progressing to end-stage renal disease (ESRD) or chronic kidney disease (CKD).

Chronic Glomerulonephritis -

The following are the causes of chronic glomerulonephritis:

• Prolonged acute untreated conditions cause chronic glomerulonephritis.

• Bacterial infections such as bacterial endocarditis, and strep throat, can cause GN.

• Viral infections such as HIV (human immunodeficiency virus), hepatitis C, or hepatitis B.

• Hereditary kidney disease.

• Other diseases like IgA nephropathy, a disorder in which kidney tissues are destroyed by antibodies called IgA.

• Lupus nephritis (results from lupus autoantibodies affecting the kidney structures).

• Endocarditis (infection of the valves of the heart).

• Physical injury to kidneys.

What Are the Signs and Symptoms of Glomerulonephritis (GN)?

• Hematuria - Pink or red-colored urine due to red blood cells.

• Proteinuria - Appearance of foamy urine due to protein inside the blood.

• Oliguria - Reduced frequency and amount of urine.

• Edema - Patients also present with face, abdomen, and extremities swelling due to fluid retention.

• Anemia - Decrease in hemoglobin concentration in the blood due to blood loss or destruction of red blood cells.

• Epistaxis - Nosebleed can also be a symptom.

• Hypertension - Elevation in blood pressure than normal.

• Headache - Headache occurs secondary to hypertension.

• Dyspnea - Shortness of breath

• Delirium - Change in the mental state.

Other symptoms include:

• Nausea and vomiting.

• Fatigue.

• Presence of a rash.

• High cholesterol.

• Fever.

• Blood in the vomit or stools.

• Damage to other organs.

• Diarrhea.

What Are the Tests to Confirm Glomerulonephritis?

1. Urine Test:

Urine analysis provides results for the presence of protein and red blood cells, creatinine clearance, urine-specific gravity, total urine protein, and uric acid in the urine.

2. Blood Test:

Blood analysis is used to measure the high level of creatinine, decrease in the number of RBCs, abnormal albumin levels, abnormal blood urea nitrogen, and increased serum electrolytes like potassium in patients with severe renal disease.

3. Imaging Tests:

Computerized Tomography (CT) scan uses X-rays to verify the site and extent of damage in the kidneys.

4. Kidney Ultrasound:

To check the size of a kidney or for the presence of any blockages in the kidneys.

5. X-Ray:

To check for the presence of inflammation and hemorrhage.

6. Kidney Biopsy:

A percutaneous spring-loaded semi-automatic biopsy gun can be used for biopsy to remove a piece of renal tissue. Biopsy indicates the proportion of involved glomeruli (diffuse or focal) and the presence of hypercellularity.

How to Treat Glomerulonephritis?

The severity of symptoms depends on if the condition is acute or chronic. Acute conditions can revert to normal sooner than chronic conditions. However, swelling seen on the face and extremities should not be overlooked. For chronic GN, the body needs to reduce the amount of protein, salt, and potassium. Calcium supplements and diuretics are recommended.

Changes to Be Made in the Diet: Dietary changes should include reduced intake of a higher amount of potassium, salt, and fluid. This helps in controlling high blood pressure and regulates the amount of fluid inside the body.

Drugs to Treat Glomerulonephritis:

• Immunosuppressants: Immunosuppressants work by suppressing the immune system and treating severe types of GN caused by problems with the immune system. Example - Cyclophosphamide, Cyclosporin.

• Corticosteroids: These drugs works as immunosuppressant drugs. They reduce inflammation.

• Diuretics: Reduces inflammation or swelling.

• Drugs to Treat Hypertension: ACE (angiotensin-converting enzyme) inhibitors or angiotensin II receptor blockers are used.

• Dialysis: If the inflammation persists and the condition worsens to cause renal failure, it may need dialysis. Dialysis is artificially purifying the blood outside the body using a machine called a dialyzer. In some cases, when the dialysis declines, a kidney transplant from healthy donors might help.

• Plasmapheresis: Another system to reduce inflammation is plasmapheresis; this process removes the fluid part of the blood and replaces it with intravenous fluid that contains no antibodies.

What Are the Complications Related to Glomerulonephritis?

• End-Stage Renal Disease (ESRD) - A medical condition in which the kidneys stop functioning, leading to kidney failure and requiring dialysis or kidney transplant for survival.

• Chronic Kidney Disease - Chronic systemic diseases causing kidney impairment is called chronic kidney disease.

• Acute Kidney Injury - Acute kidney injury or acute kidney failure occurs when the kidney injury occurs in a short span, like a few hours or a few days.

• Chronic Kidney Injury - The gradual loss of kidney function over time is chronic kidney disease.

• Urinary Tract Infections - Infections in the urinary system like kidneys, ureter, bladder, and urethra are called urinary tract infections. The symptoms include painful urination and pressure in the lower belly.

• Pulmonary Edema - Fluid collection in the air sacs of the lungs is called pulmonary edema.

• Congestive Heart Failure - Heart failure due to fluid overload.

• Kidney Failure - Kidney failure occurs when the GN condition is left untreated. In kidney failure, one or both the kidneys stop working; if that happens, dialysis is required permanently.

• Hypertension - Elevated blood pressure.

• Compromised Immunity - Weakened immunity susceptible to infections.

How to Prevent Glomerulonephritis?

• Eat healthy and with less sodium.

• Avoid processed food as they contain a high amount of salt.

• Practice and maintain good oral hygiene.

• Visit a physician if you are suffering from strep throat.

• Quit smoking.

• Maintain average body weight.

• Limit intake of potassium, phosphorus, and magnesium.

Conclusion:

Acute and chronic symptoms of GN can still be regulated if the guidelines are followed strictly. In addition, regular exercise and diet management can prevent the worsening of the condition.

Early diagnosis and treatment are the keys to healthy kidneys. Regular body check-ups can help you keep a record of the changes inside the body, which can rule out any damage. In addition, patients suffering from hepatitis B and C, diabetes mellitus, high blood pressure, or any other immunocompromised condition must make dietary changes and avoid worsening the situation that is already present.