Table of Contents
Definition of Glomerulonephritis
The glomerulus is the coiled capillary network through which BLOOD circulates for filtration.
Glomerulonephritis, also called glomerular disease, may be acute (come on suddenly) or chronic (develop slowly over time). Acute glomerulonephritis is often a temporary condition that improves with treatment and causes minimal or no residual damage to the glomeruli.
Chronic glomerulonephritis tends to be progressive, eventually deteriorating to RENAL FAILURE and END-STAGE RENAL DISEASE (ESRD). INFECTION, AUTOIMMUNE DISORDERS, NEPHROPATHY of DIABETES, and nephropathy of HYPERTENSION (high BLOOD PRESSURE) are the most common identified causes of glomerulonephritis. As often as not, however, the nephrologist cannot determine the cause and focuses instead on treatment.
Symptoms and Diagnostic Path
The symptoms of glomerulonephritis may be minimal and difficult to detect or obvious and debilitating, depending on whether the condition is chronic or acute.
Common symptoms of glomerulonephritis include
- edema (swelling or puffiness) of the face, hands and wrists, and feet and ankles
- discolored URINE (commonly described as teacolored or cola-colored)
- foamy urine (ALBUMINURIA)
The diagnostic path begins with urinalysis, which typically reveals HEMATURIA (blood in the urine) and albuminuria (excessive ALBUMIN, or protein, in the urine). In many people, urinalysis done as part of a ROUTINE MEDICAL EXAMINATION provides the first indication of glomerulonephritis. Blood tests help the nephrologist assess the ability of the kidneys to remove toxins and wastes from the blood. Imaging procedures such as abdominal ULTRASOUND or COMPUTED TOMOGRAPHY (CT) SCAN can show the damage to the glomeruli. Needle biopsy of the kidney tissue allows microscopic examination of the glomeruli, providing the definitive diagnosis.
Treatment Options and Outlook
Treatment targets either the underlying condition or the resulting symptoms. Because hypertension is nearly always either a cause or a consequence of glomerulonephritis, the doctor is likely to prescribe medications that lower blood pressure (antihypertensives) such as beta blockers, angiotensin-converting enzyme (ACE) inhibitors, or calcium channel blockers.
The doctor may also prescribe medications to extract more water from the blood (diuretics), which lowers blood pressure as well as eases the workload of the kidneys. Bacterial infections require ANTIBIOTIC MEDICATIONS. Viral infections, which are fairly common, will run their course after which kidney function usually returns to normal.
Acute glomerulonephritis may result in renal failure, requiring short-term RENAL DIALYSIS to remove wastes and toxins from the blood until kidney function returns enough to resume this functions. CORTICOSTEROID MEDICATIONS and other immunosuppressive therapies are necessary when the cause of the glomerulonephritis is an autoimmune disorder.
Once the cause of the inflammation resolves, the glomerulonephritis generally resolves as well, and kidney function returns to normal. Chronic glomerulonephritis may require long-term medication therapy, and presents a significant risk for progression to ESRD despite treatment.
Risk Factors and Preventive Measures
Diabetes and hypertension are the leading risk factors for glomerulonephritis. Keeping these conditions under control with medications and lifestyle methods lowers the likelihood for damage to the kidneys and can slow the progression of chronic glomerulonephritis.
Untreated or undertreated (failing to complete the full course of antibiotics) strep infections such as STREP THROAT or IMPETIGO remain a significant source of bacterial infection that causes glomerulonephritis.
Though there are no methods for preventing glomerulonephritis, the doctor may recommend measures to slow its progression such as dietary modifications (less sodium, potassium, and protein; more water consumption).