Hepatic Glomerulonephritis - Causes, Symptoms, Diagnosis, and Treatment

What Is Hepatic Glomerulonephritis?

Hepatic glomerulonephritis is a form of secondary glomerulonephritis caused by underlying liver disease. Glomerulonephritis is an inflammation of the glomeruli. Glomeruli are structures within the kidney that are made of small blood vessels. These vascular nodes help filter the blood and remove excess water. If the glomeruli are damaged, the kidneys may not function properly, leading to renal failure. Glomerular changes occur mainly in patients with cirrhosis and acute or chronic viral hepatitis. Glomerulonephritis in patients with cirrhosis occurs in 50 percent to 100 percent of cases.

What Are the Causes of Hepatic Glomerulonephritis?

In liver disease, impaired removal of immune complexes causes entrapment in the kidney, leading to lesions of hepatic immunoglobulin A (IgA) nephropathy and hepatic glomerulonephritis. In addition, vasoconstriction (narrowing of the blood vessels) of the kidney and hypovolemia (reduced circulating blood volume) leads to the filtration load on the kidneys, causing glomerulonephritis.

What Are the Types of Hepatic Glomerulonephritis?

Glomerulonephritis is caused by:

• Cirrhosis of the liver.

• Acute viral hepatitis and hepatitis B infection.

• Hepatitis C virus (HCV) related nephritis.

What Are the Symptoms of Hepatic Glomerulonephritis?

Signs and symptoms of glomerulonephritis include:

• Pink or cola-colored urine (hematuria) due to red blood cells in the urine.

• Foamy urine due to an increased amount of protein in the urine (proteinuria).

• High blood pressure (hypertension).

• Fluid retention (edema) with visible swelling in the face, hands, feet, or abdomen.

• Urinating less than usual.

• Nausea and vomiting.

• Muscle spasms.

What Are the Possible Complications of Hepatic Glomerulonephritis?

Glomerulonephritis impairs the nephron’s ability to filter blood flow effectively. This impairment of filtering results in the following:

• Accumulation of waste products or toxins in the bloodstream.

• Mal regulation of essential minerals and nutrients.

• Red blood cell loss.

• Blood protein loss.

Possible Complications of Hepatic Glomerulonephritis Include:

• Acute Renal Failure - Acute renal failure is the sudden, rapid decline in renal function and is often associated with infectious causes of glomerulonephritis. Accumulation of waste products and fluids can be fatal if not treated quickly with an artificial filter (dialysis).

• Hypertension - Glomerular damage due to inflammation and scarring can lead to increased blood pressure.

• Nephrotic Syndrome - Nephrotic syndrome is a condition with too much blood protein in the urine and too little protein in the bloodstream. These proteins play a role in regulating fluid and cholesterol levels. Low blood protein leads to high cholesterol, high blood pressure, and swelling of the face, hands, feet, and abdomen (edema). Rarely, nephrotic syndrome can cause blood clots in the kidneys.

When to Get Help?

A physician’s appointment should be sought right away if any symptoms of hepatic glomerulonephritis are noticed.

How Is Hepatic Glomerulonephritis Diagnosed?

Hepatic glomerulonephritis can be identified by testing when acute illness is present, during routine check-ups, or appointments for the treatment of the chronic liver condition; tests to diagnose hepatic glomerulonephritis include:

• Urinalysis - The test may reveal signs of decreased kidney function; for example, red blood cells and proteins should not be present in urine or white blood cells, which are signs of inflammation.

• Blood Test - Analysis of blood samples reveals higher than normal levels of waste products in the bloodstream. As a result, antibodies in the blood may indicate an autoimmune disease, bacterial or viral infections, or blood sugar levels that indicate diabetes.

• Imaging Test - The physician may recommend imaging tests. Imaging tests may show a difference in the shape and size of the kidneys. These tests include X-rays, ultrasounds, or CT (computerized tomography) scans.

• Renal Biopsy - This procedure uses a needle to extract a small piece of kidney tissue and examine it under a microscope. A biopsy is used to confirm the diagnosis and assess the extent and type of tissue damage.

How Is It Treated?

Treatment of glomerulonephritis and its outcome depends on the nature and severity of the signs and symptoms.

1. The goal of treatment is to protect the kidneys from further damage and preserve kidney function. One of the treatment options is to control high blood pressure. Controlling blood pressure may be very hard when the kidneys aren’t working properly. If this is the case, the physician may prescribe blood pressure medications containing angiotensin-converting enzyme inhibitors (ACE inhibitors), such as:

• Captopril.

• Lisinopril.

• Perindopril.

2. Physicians may also prescribe angiotensin receptor blockers or ARBs, such as:

• Losartan.

• Irbesartan.

• Valsartan.

3. Corticosteroids may also be used if the immune system is attacking the kidneys. They lower the immune response.

4. Another method to lower immune-triggered inflammation is plasmapheresis. This process extracts the fluid component of the blood, called plasma, and replaces it with antibody-free intravenous fluids or donated plasma.

5. The amount of protein, salt, and potassium in the diet should be reduced for chronic hepatic glomerulonephritis. Additionally, there should be an adequate daily intake of liquids, and the intake should be monitored. Calcium supplements may be recommended, and there is a need to take diuretics to reduce swelling. Physician’s advice is recommended, or a nephrologist’s for guidelines about diet restrictions or supplements. A medical dietician may also be consulted for the same.

6. Dialysis may be required if the condition progresses and develops into kidney failure. In this procedure, a machine filters the blood. Eventually, there may be a need for a kidney transplant.

7. Lifestyle and Home Remedies:

• Reduce salt intake to prevent or minimize fluid retention, bloating, and high blood pressure.

• Decrease protein and potassium intake to slow the accumulation of waste products in the blood.

• Maintain a healthy weight.

• Take medicines as directed by the physician.

• Quit smoking.

How Can Hepatic Glomerulonephritis Be Prevented?

Some types of hepatic glomerulonephritis cannot be prevented. However, here are some steps that may be beneficial:

• Prevent infections like hepatitis that can lead to hepatic glomerulonephritis, follow safe sex guidelines and avoid sharing injectable drugs needles.

• Control high blood pressure and reduce the chances of kidney damage due to high blood pressure.

• Avoid excessive consumption of alcohol.

• Prevent liver damage by avoiding drugs that can harm the liver.

• Prevent unclean water and junk food.

Conclusion

Hepatic glomerulonephritis is a disease caused secondary to a liver ailment; hence appropriate. However, measures should be taken to prevent it in the first place. If it does occur, timely reversal is important for preventing permanent kidney damage.