Glomerulonephritis

English: Henoch–Schönlein purpura
English: Henoch–Schönlein purpura (Photo credit: Wikipedia)

Alternative Names: Glomerulonephritis – chronic; Chronic nephritis; Glomerular disease; Necrotizing glomerulonephritis; Glomerulonephritis – crescentic; Crescentic glomerulonephritis; Rapidly progressive glomerulonephritis

Definition:
Glomerulonephritis is a type of kidney disease in which the part of your kidneys that helps filter waste and fluids from the blood is damaged.

It is an inflammation of the tiny filters in your kidneys (glomeruli). Glomeruli remove excess fluid, electrolytes and waste from your bloodstream and pass them into your urine.

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The inflammation can be caused by many different conditions. but is usually due to an overactivity of the immune system.

Glomerulonephritis can be acute — a sudden attack of inflammation — or chronic — coming on gradually.

If glomerulonephritis occurs on its own, it’s known as primary glomerulonephritis. If another disease, such as lupus or diabetes, is the cause, it’s called secondary glomerulonephritis. If severe or prolonged, the inflammation associated with glomerulonephritis can damage your kidneys. Treatment depends on the type of glomerulonephritis you have.

Symptoms:
There are seven different types of glomerulonephritis, that present in very different ways. For some types, symptoms can include ankle swelling that develops over months or years. For others, shortness-of-breath over days or weeks (due to water in the lungs) causing a rapid onset of kidney failure.

The outlook is also variable, from complete recovery with no treatment, to end-stage renal failure (ESRF), requiring dialysis and/or a transplant. Some types of glomerulonephritis can return in a transplant.

The various symptoms of the different types also include:
*Swelling of the face, eyes and legs
*Reduction in urine volume
*Dark urine (containing blood which may not be visible)
*Headaches and visual disturbances
*Drowsiness
*Tiredness and general malaise (feeling ill)
*Nausea
*Loss of appetite
*Rashes and itchy skin
*Pink or cola-colored urine from red blood cells in your urine (hematuria)
*Foamy urine due to excess protein (proteinuria)
*High blood pressure (hypertension)
*Fluid retention (edema) with swelling evident in your face, hands, feet and abdomen
*Fatigue from anemia or kidney failure

Tests for the condition show protein, blood cells, and kidney cells in the urine, while a high concentration of the body’s waste products (such as urea and creatinine) may be found in the blood.

Swabs of the throat may show there’s been a streptococcal infection, while blood tests may be used to check for antibodies to streptococci or other infections, or signs of an abnormal immune response.

All patients will need a kidney biopsy (removal of a piece of kidney with a needle) to make a definite diagnosis.

Sometimes when there are no symptoms, the problem is picked up by a routine blood test, or during investigation of high blood pressure

 

Causes:
Primary causes are ones which are intrinsic to the kidney, whilst secondary causes are associated with certain infections (bacterial, viral or parasitic pathogens), drugs, systemic disorders (SLE, vasculitis) or diabetes.

Glomerulonephritis may be caused by specific problems with the body’s immune system. Often, the precise cause of glomerulonephritis is unknown.

Damage to the glomeruli causes blood and protein to be lost in the urine.

The condition may develop quickly, with loss of kidney function occurring over weeks and months (called rapidly progressive glomerulonephritis).

In about a quarter of people with chronic glomerulonephritis there is no history of kidney disease and the disorder first appears as chronic renal failure.

Risk Factors:
The following increase your risk of developing this condition:
•History of cancer
•Blood or lymphatic system disorders
•Exposure to hydrocarbon solvents
•Infections such as strep infections, viruses, heart infections,or abscesses
•Diabetes
Many conditions are known to cause or increase the risk for glomerulonephritis, including:
•Focal segmental glomerulosclerosis
•Goodpasture syndrome
•Membranoproliferative GN
•IgA nephropathy
•Lupus nephritis or Henoch-Schonlein purpura
•Anti-glomerular basement membrane antibody disease
•Blood vessel diseases such as vasculitis or polyarteritis
•Amyloidosis

In most cases, no cause is found. Though in a few patients, they may be ‘set off’ by an infection or a cancer. Post-streptococcal glomerulonephritis is now extremely rare

There is also a very serious type called ’rapidly progressive glomerulonephritis’ (RPGN), which can follow a flu-like illness in the month before symptoms start in 50 per cent of patients. This can cause kidney failure in days or weeks and can be linked to bleeding from the lungs, causing blood to be coughed up.

 

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Diagnosis:
Specific signs and symptoms may suggest glomerulonephritis, but the condition often comes to light when a routine urinalysis is abnormal. Because symptoms develop gradually, the disorder may be discovered when there is an abnormal urinalysis during a routine physical or examination for unrelated disorders.

Glomerulonephritis can cause high blood pressure. It may only be discovered as a cause of high blood pressure that is difficult to control.

Laboratory tests may reveal anemia or show signs of reduced kidney functioning. A kidney biopsy confirms the diagnosis.

Later, signs of chronic kidney failure may be seen, including swelling (edema), polyneuropathy, and signs of fluid overload, including abnormal heart and lung sounds.

Imaging tests that may be done include:
•Abdominal CT scan
•Abdominal ultrasound
•Chest x-ray
•IVP

Urinalysis and other urine tests include:
•Examination of the urine under a microscope
•Creatinine clearance
•Total protein
•Uric acid, urine
•Urine concentration test
•Urine creatinine
•Urine protein
•Urine RBC
•Urine specific gravity

This disease may also affect the results of the following blood tests:
•Albumin
•Anti-glomerular basement membrane antibody test
•Anti-neutrophil cytoplasmic antibodies (ANCAs)
•BUN and creatinine
•Complement component 3
•Complement levels

Treatment:
Treatment varies depending on the cause of the disorder, and the type and severity of symptoms. High blood pressure may be difficult to control, and it is generally the most important aspect of treatment.

Medicines that may be prescribed include:
•Blood pressure medications are often needed to control high blood pressure. Angiotensin-converting enzyme inhibitors and angiotensin receptor blockers are most commonly prescribed.
•Corticosteroids may relieve symptoms in some cases.
•Medications that suppress the immune system may also be prescribed, depending on the cause of the condition.

A procedure called plasmapheresis may be used for some cases of glomerulonephritis due to immune-related causes. The fluid part of the blood containing antibodies is removed and replaced with intravenous fluids or donated plasma (without antibodies). Removing antibodies may reduce inflammation in the kidney tissues.

Dietary restrictions on salt, fluids, protein, and other substances may be recommended.

Persons with this condition should be closely watched for signs that they are developing kidney failure. Dialysis or a kidney transplant may eventually be necessary.

Lifestyle and home remedies:-
Your doctor may recommend lifestyle changes, including:

*Restricting salt intake to prevent or minimize fluid retention, swelling and hypertension

*Cutting back on protein and potassium consumption to slow the buildup of wastes in your blood

*Maintaining a healthy weight

*Controlling your blood sugar level if you have diabetes

Possible Complications:
•Nephrotic syndrome
•Acute nephritic syndrome
•Chronic kidney failure
•End-stage kidney disease
•Hypertension
•Malignant hypertension
•Fluid overload — congestive heart failure, pulmonary edema
•Chronic or recurrent urinary tract infection
•Increased susceptibility to other infections
•Hyperkalemia

Prognosis:
Glomerulonephritis may be a temporary and reversible condition, or it may get worse. Progressive glomerulonephritis may lead to chronic kidney failure and end-stage kidney disease.

If you have nephrotic syndrome and it can be controlled, other symptoms may also be controlled. If it can’t be controlled, end-stage kidney disease may result.

 

Prevention:
There is no specific way to prevent most cases of glomerulonephritis. Some cases may be prevented by avoiding or limiting exposure to organic solvents, mercury, and nonsteroidal anti-inflammatory drugs (NSAIDs).

Disclaimer: This information is not meant to be a substitute for professional medical advise or help. It is always best to consult with a Physician about serious health concerns. This information is in no way intended to diagnose or prescribe remedies.This is purely for educational purpose.

Resources:
http://www.bbc.co.uk/health/physical_health/conditions/in_depth/kidneys/glomerulonephritis1.shtml
http://www.nlm.nih.gov/medlineplus/ency/article/000484.htm
http://www.mayoclinic.com/health/glomerulonephritis/DS00503
http://en.wikipedia.org/wiki/Glomerulonephritis

http://www.marvistavet.com/html/body_glomerulonephritis.html

http://www.butler.org/body.cfm?id=125&chunkiid=96731

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