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GLOMERULONEPHRITIS

What is Glomerulonephritis ?

The two kidneys are situated in the back of the abdomen. They remove waste products and excess water from blood to make urine. The urine then passes down the ureter on each side into the bladder. Glomerulonephritis is an inflammation of the kidneys. Both kidneys are always affected at the same time. There are many types of glomerulonephritis. The damage to the kidneys varies with the type of glomerulonephritis. The symptoms therefore vary from patient to patient. There may be no symptoms at all: blood and/or protein may be found accidentally in the urine doing a routine test. If there is a lot of protein in the urine, then you may develop a condition called nephrotic syndrome. This consists of marked fluid overload with puffiness, particularly of the legs and face (oedema). You may notice blood in the urine. In some types of glomerulonephritis, kidney function may be reduced, resulting in a build-up of waste substances. This causes fatigue and general sickness, and often high blood pressure. Rarely, the kidneys may stop working over a few weeks; you will then get all the symptoms of acute renal failure.

How does Glomerulonephritis occur ?

In most cases it is not known how the damage occurs in the kidneys. In some cases, the damage is thought to be caused by antibodies (kinds of abnormal protein). These get from the blood into the kidneys. Here, the antibodies react with the cells found in the kidney. The inflammation which results from this makes the kidney leak protein into the urine. The inflammation can also block the tiny blood-vessels so that the kidneys do not work properly, or may stop working altogether.

Why does Glomerulonephritis occur ?

In most cases, the cause of the glomerulonephritis is unknown. Sometimes the glomerulonephritis occurs after an acute infection, most commonly a sore throat; this type is called acute nephritis. Glomerulonephritis can also be a feature of other diseases such as arteritis or systemic lupus erythematosus. Certain drugs such as gold or penicillamine can also cause glomerulonephritis.

Treatment Involved for Glomerulonephritis

The first step is to see what type of glomerulonephritis has occurred. This can only be done by a renal biopsy. This involves taking a tiny sample of kidney tissue through a needle in the side of the back. The sample is examined under a microscope (renal biopsy). This will help predict whether kidney function is going to be normal, get worse, or get better. If the patient is being treated with gold or penicillamine, then these are stopped (both are used in the treatment of rheumatoid arthritis). For the other types of glomerulonephritis, different drugs can be used. Steroids (cortisone-like drugs) and immunosuppressive drugs (like azathioprine and cyclophosphamide) are often given. They all work by stopping an abnormal antibody from damaging the cells of the kidney filter. Sometimes patients are treated with plasma exchange. For this purpose, blood is pumped through a special filter which removes the patient's (unhealthy) plasma, leaving behind only the red blood cells. Normal plasma, taken from a number of healthy people, is then given to the patient in its place. Some types of glomerulonephritis will get better on their own, e.g. acute nephritis. In many cases, kidney function will remain normal although some blood and/or protein may be found in the urine. In other cases, the blood pressure may rise and/or kidney function will get worse. A small percentage of patients will develop chronic kidney failure needing dialysis. This worsening of kidney function may occur over many years and can be slowed down by really good control of blood pressure. There is also some evidence that by eating less protein, the worsening of kidney failure may be slowed down. Accordingly an appointment may be made for you to discuss diet with a dietitian.

During Treatment for Glomerulonephritis

If on steroids there may be a gain in weight and puffiness of the face. If high doses are used, then there is a risk of bleeding from the stomach or the development of diabetes. Azathioprine and cyclophosphamide both reduce the number of white blood cells made in the bone marrow. This increases the risk of infection. You should therefore tell your doctor of any fever or cough. Should the treatment not work, or if a type of glomerulonephritis has occurred that can cause permanent kidney damage, then the symptoms of chronic renal failure develop. High blood pressure may also occur. Although this may not cause any symptoms, the blood pressure must be kept under good control. This can be easily done with tablets. Control of the blood pressure is important. Not only does it prevent the complications of high blood pressure itself: it also slows down the worsening of any kidney damage. The doctor will therefore measure blood pressure at each visit.

After Treatment for Glomerulonephritis

This depends on the amount of kidney damage and the type of glomerulonephritis. If the renal biopsy shows a type which does not cause kidney damage, then you only need a visit to the doctor every few months. He will check kidney function and blood pressure. If high blood pressure or kidney failure develops, then more frequent visits will be necessary.

If Glomerulonephritis is Left Untreated

If the type of glomerulonephritis requires drug treatment, then not having the drug increases the chances of developing severe kidney failure, requiring dialysis. Although a milder type of glomerulonephritis may have been diagnosed, one might still develop high blood pressure. If this is not measured (and therefore not treated), there is a bigger risk of getting heart disease or a stroke. If kidney failure is not recognized and treated, you may become very ill. This could result in having to be admitted to hospital as an emergency for urgent dialysis. The risks of such urgent dialysis are always much higher.

Effects on Family of Glomerulonephritis

If kidney function does get worse, your doctor will probably wish to have a family discussion to start making plans for the best sort of dialysis.