Glomerulonephritis (GN) is inflammation of the glomeruli, the tiny filtering units in the kidneys. Learn about the causes, risk factors, symptoms, diagnosis, treatment options, and ways to protect kidney function and prevent complications.
Glomerulonephritis (GN) is a medical term for a group of renal diseases involving inflammation and damage to the glomeruli (the tiny filters in the kidneys that remove waste and excess fluid from the blood), usually caused by the body’s immune system. This condition can lead to serious complications, including kidney failure, if not diagnosed and treated promptly. This guide provides an in-depth of the causes, symptoms, diagnosis, treatment options and complications for glomerulonephritis.
Glomerulonephritis refers to a group of kidney disorders characterized by damage to the glomeruli, the small filtering units of the kidney, typically caused by immune system activity. This condition can lead to kidney dysfunction, allowing protein (proteinuria) and sometimes blood (hematuria) to enter the urine.
Glomerulonephritis occurs when the glomeruli become inflamed and scarred, which can impair their ability to filter waste and excess fluids from the blood. If left untreated, this damage may progress to kidney failure. There are two primary types of glomerular disease: glomerulonephritis and glomerulosclerosis, the latter involving scarring and hardening of blood vessels in the kidneys.
The nephron, which is the fundamental structural and functional unit of the kidney, consists of a renal corpuscle (glomerulus enclosed by Bowman’s capsule) and a renal tubule. Each human kidney contains approximately one million nephrons. The glomerular filtration barrier is composed of a fenestrated endothelium, a glomerular basement membrane (GBM), and podocytes, which are specialized epithelial cells. In glomerulonephritis, the immune system attacks components of the glomeruli, leading to injury in the GBM, mesangium, or capillary endothelium. This damage results in hematuria, proteinuria, and azotemia, indicating impaired kidney function.If the kidneys lose their ability to properly filter blood, complications such as fluid retention, high blood pressure, and kidney failure may arise.
The following may increase your risk for glomerulonephritis:
Glomerulonephritis occurs when the glomeruli, the filtering units of the kidney, become damaged, leading to proteinuria (protein loss in urine), hematuria (blood in urine), and potential kidney failure. The condition may arise due to immune system dysfunction, infections, toxins, or medications. In many cases, the exact cause remains unknown.The immune system, which typically fights infections, can mistakenly attack the glomeruli, causing inflammation and scarring. In some cases, the immune system dysfunction may have no clear trigger, while in others, infections or other factors may initiate the immune response.
Certain infections can trigger immune-related kidney damage, leading to glomerulonephritis:
Glomerulonephritis is classified based on its onset, underlying causes, and microscopic changes in kidney tissue. It can be categorized into acute and chronic forms, as well as primary or secondary glomerulonephritis.
Primary Glomerulonephritis: Develops independently without any underlying disease or condition.
Secondary Glomerulonephritis: Occurs as a complication of another illness, such as systemic lupus erythematosus (SLE) or polyarteritis nodosa.
Acute glomerulonephritis occurs suddenly, often following infections such as strep throat. It can also result from autoimmune conditions like lupus, Wegener's disease, and Goodpasture's syndrome. Without prompt treatment, it can lead to kidney failure.
Chronic glomerulonephritis progresses slowly over years, often without noticeable symptoms in its early stages. Over time, it can cause irreversible kidney damage and lead to chronic kidney disease (CKD).
A kidney biopsy can further classify glomerulonephritis based on microscopic changes in kidney tissue (kidney biopsy). The classifications are as follows;
Focal and Segmental Glomerulosclerosis (FSGS): This is the scarring or sclerosed of only some part of the glomeruli (focal) and partial damage to individual glomerulus (segmental)
IgA Glomerulonephritis: Caused by IgA antibody deposits (one of the antibodies produced by the immune system to fight infection), leading to inflammation and scarring.
IgM Glomerulonephritis: Damage occurs due to IgM antibody deposits in the glomeruli.
Membranoproliferative Glomerulonephritis: In this type, both the glomerular membrane and the mesangium is affected, leading to structural damage.
Membranous Glomerulonephritis: This involves solely damage to the glomerular membrane, whiles the mesangium is not affected
Minimal Change Nephropathy: Kidney tissue appears essentially normal under a microscope when sample of affected kidney is taken, but symptoms of glomerulonephritis persist. This is a common type in children.
Glomerulonephritis (GN) presents with various signs and symptoms depending on whether it is acute or chronic. In some cases, the condition can progress silently, with kidney damage occurring before noticeable symptoms appear.
Acute glomerulonephritis develops suddenly, often after an infection or immune system trigger. Symptoms may include:
Chronic glomerulonephritis can develop slowly over time, sometimes without noticeable symptoms in its early stages. When symptoms do appear, they often include:
Diagnosing glomerulonephritis involves a range of investigations to assess kidney function and identify possible underlying causes. Various tests help detect abnormalities in the urine and blood, as well as structural changes in the kidneys if glomerulonephritis is suspected. These may include:
A kidney biopsy is often performed to confirm the diagnosis and determine the specific type of glomerulonephritis. In this procedure, a small sample of kidney tissue is obtained using a needle under ultrasound guidance. The tissue sample is examined under a microscope to assess structural changes, inflammation, and potential causes of glomerular damage.
Treatment for glomerulonephritis depends on the underlying cause of the condition, as well as the type and severity of symptoms. Managing high blood pressure is often a critical part of treatment to protect kidney function and prevent further complications.
Medications for Glomerulonephritis
Several types of medications may be prescribed to treat glomerulonephritis and its associated symptoms
Blood Pressure Medications: Angiotensin-converting enzyme (ACE) inhibitors and angiotensin receptor blockers (ARBs) are commonly used to manage high blood pressure and protect kidney function. Examples include:
Corticosteroids: These medications help reduce inflammation that leads to kidney damage and scarring.
Immunosuppressive Drugs: In cases where glomerulonephritis is caused by an autoimmune reaction, immunosuppressive drugs may be used to slow disease progression and reduce kidney inflammation.
Diuretics (Water Pills): These medications help remove excess fluid from the body by increasing urine production, which can relieve swelling (edema).
Plasmapheresis: In cases where glomerulonephritis is caused by immune system problems, plasmapheresis may be used to remove harmful antibodies from the blood. During this procedure, the plasma (the fluid part of blood that contains antibodies) is removed and replaced with intravenous fluids or donated plasma free of antibodies. This process helps reduce inflammation and damage to the kidney tissues.In a more advance cases, patients with severe or chronic glomerulonephritis that leads to kidney failure, more intensive treatment options may be necessary:
Dialysis: If the kidneys can no longer effectively remove waste and excess fluids from the body, dialysis may be required to filters the blood to remove waste, excess fluids, and toxins.
Kidney Transplant: In cases where kidney function is severely impaired and irreversible, a kidney transplant may be considered.
Certain dietary restrictions can help manage glomerulonephritis and protect kidney function:
The subsequent measures are essential for effectively caring for patients with Glomerulonephritis
Personal hygiene
Nutrition
Emotional support/psychological care
Complications of glomerulonephritis can include:
Preventing glomerulonephritis involves addressing its underlying causes and reducing risk factors that contribute to kidney damage. If you have kidney disease certain lifestyle changes maybe recommended:
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