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Glomerulonephritis

  • What is glomerulonephritis?

    Glomerulonephritis

    Glomurelonephritis is a kidney disease caused by the inflammation of small blood vessels in the kidney. The role of the glomeruli is to remove excess waste and fluid from your bloodstream and to excrete into your urine. Glomurelonephritis due to either a sudden onset of glomeruli inflammation (acute), or a gradual onset (chronic) causes the glomeruli to malfunction and the kidney to not be able to filter waste products from the blood normally.

    There are 4 types of glomerulonephritis:

    IgA nephropathy

    This is caused by the deposits of immunoglobulin A (IgA) in the glomeruli, which is characterised by occurrence of blood and protein the urine. This disease can progress for years without noticeable symptoms.

    Focal segmental global sclerosis

    This condition results from another disease or occurs without known reasons. It is characterised by scattered scarring of some of the glomeruli and can lead to kidney failure.

    Membranous glomurelonephritis

    This condition occurs when the glomeruli become damaged and thickened. Protein leak results from the damaged blood vessels into the urine, which may cause signs and symptoms known as nephrotic syndrome.

    Systemic lupus erythematosus

    This is a systemic autoimmune disease that occurs when the body's immune system attacks your tissues and organs. The inflammation caused by this condition can affect many different body systems, such as your joints, skin, kidneys, blood cells, brain, heart, and lungs.

  • There are various conditions that can cause glomerulonephritis. These may include:

    Autoimmune disease

    Glomerulonephritis may be caused by a specific immune system problem (autoimmune disease). One such example would be IgA nephropathy, where antibody (immunoglobulin A) deposits in the glomureli, causing the glomureli to swell. The exact mechanism of IgA nephropathy is not fully understood, and the disease can develop for years before it is detected.

    • Primary glomerulonephritis affects the kidneys directly
    • Secondary glomerulonephritis is generally due to bacterial infections (streptococcal throat infection), viral infections (HIV and hepatitis viruses’ infections), heart infections (bacterial endocarditis), cancers, diabetes, high blood pressure and abscesses.

    Lupus

    Inflammation caused by lupus can affect different areas of your body, including your kidneys. Lupus results in serious kidney damage. Kidney failure is one of the main causes of death among people with lupus.

    Goodpasture’s disease

    This rare immunological lung disorder can mimic pneumonia. Goodpasture's syndrome results in bleeding in the lungs, as well as glomerulonephritis.

    Risk factors for glomurelonephritis

    Your chances of developing glomurelonephritis may increase with the following:

    • Family history of kidney disease and infection. Genetic factors can play a role in glomerulonephritis.
    • Immune system diseases. Conditions such as lupus and diabetes may cause scarring of the glomeruli that can also lead to glomerulonephritis. Protein in the urine and kidney failure might occur when growth factors activate the glomerular cells to produce scar materials.
    • Long-term use of antibiotics or pain medications. Long-term use of certain medications that include non-steroidal anti-inflammatory drugs (NSAIDs), which are drugs that relieve or reduce pain, such as aspirin or ibuprofen, increases the risk of glomerulonephritis.
    • Recent surgery of the urinary tract. Surgery can sometimes cause problem in your urine flow. Surgery complications may cause the urine to flow backward or reflux into your kidneys instead of flowing from your kidneys to your bladder.

    Preventing glomurelonephritis

    There is no way to prevent most forms of glomerulonephritis, but the following steps can help lower your risk of developing the disease:

    • Seek prompt treatment of a strep infection with a sore throat or impetigo
    • Follow safe-sex guidelines and avoid intravenous drug use to prevent infections that lead to glomerulonephritis
    • Prevent and control risk factors like hypertension, diabetes and obesity to minimise damage to the kidneys
  • The symptoms of glomerulonephritis are often experienced when the glomeruli are severely damaged. Symptoms may include:

    • Changes in urine colour (dark or pink)
    • Foamy urine (due to protein in urine)
    • Headache, sickness, fever and chills
    • High blood pressure
    • Reduced urine production
    • Swelling of legs, hands and face due to excess fluid retention (oedema)
  • After checking your symptoms and medical history, your doctor will require some diagnostic tests, including:

    Urine test

    A urine test may show red blood cells and red cell casts in your urine, which is an indicator of possible damage to the glomeruli. The results may also show white blood cells that indicate infection or inflammation and increased protein that can reveal nephron damage. Increased blood levels of creatinine or urea are also red flags.

    Blood test

    A blood test provides information about kidney damage and impairment of the glomeruli. It is done by measuring levels of waste products, such as blood urea nitrogen and creatinine.

    Imaging tests

    Your doctor may recommend diagnostic studies that allow visualisation of your kidneys. Imaging tests such as a kidney X-ray, an ultrasound exam, or a computed tomography (CT scan) are done if he detects evidence of damage.

    Kidney biopsy

    In a kidney biopsy, a special needle is used to extract small pieces of kidney tissue for microscopic examination. This is helpful in investigating the cause of the inflammation. This procedure is almost always necessary to confirm a diagnosis of glomerulonephritis.

  • The treatment options for glomerulonephritis vary depending on the causes and severity of your symptoms. These include:

    Medications and therapeutics

    Your doctor may prescribe blood pressure medications, such as angiotensin-converting enzyme (ACE) inhibitors. Angiotensin receptor blockers or ARBs, including losartan, irbesartan and valsartan, may also be prescribed. If your immune system is attacking your kidneys, corticosteroids and other medications to suppress the immune system may also be prescribed to reduce the immune response.

    In addition, your doctor may also recommend plasmapheresis, a procedure to reduce immune-triggered inflammation. This method removes the fluid part of your blood, which is the plasma, and replaces it with intravenous fluids or donated plasma that contains no antibodies.

    Dietary changes

    Follow dietary changes advised by your doctor. This may include control of salt and water intake (to reduce fluid retention) and cutting back protein and potassium intake (to minimise waste accumulation in the body).

    Surgery

    If your condition becomes advanced and you develop kidney failure, dialysis or other forms of treatments to replace kidney function might be needed. Dialysis can help remove excess fluid and control high blood pressure for glomerulonephritis. When a kidney transplant is not possible due to poor general health or other reasons, haemodialysis, in which a machine filters your blood or peritoneal dialysis (also called as water dialysis), may be the only options for active management.

    Conservative care or palliative care may be considered in select situations based on the patient's condition and preferences.

    Speak to a specialist to find out the best treatment option for you.

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  • Glomerulonephritis may lead to several health complications, including:

    High blood pressure

    High blood pressure is a result of damage to your kidneys and the resulting buildup of wastes in the bloodstream. Blood pressure is indicated by the amount of blood your heart pumps and the amount of resistance to blood flow in your arteries.

    Kidney disease

    Your kidneys may gradually lose their filtering ability. End-stage kidney disease that requires dialysis or a kidney transplant to sustain life may occur if kidney function deteriorates to less than 10% of normal capacity.

    Kidney failure

    The deterioration of ability in the filtering part of the nephron results in the rapid accumulation of waste products. Emergency dialysis by an artificial kidney machine, an artificial means of removing extra fluids and waste from your body, will be necessary.

    Nephrotic syndrome

    This syndrome occurs when there is too much protein in your urine that results in too little protein in your blood. It can be linked with high blood cholesterol and swelling or oedema of the feet, abdomen, and eyelids. Besides damaging the kidneys, such leakage of proteins may lead to increased risk of blood clots and elevated risk for some infections.

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