Glomerulonephritis

Glomerulonephritis: Description:GlomerulonephritisRenal disease characterized by diffuse inflammatory changes in glomeruli that are not the acute response to infection of the kidneys. Syn: glomerular nephritis.Abbreviation: GN.Terminology related to glomerulonephritis:
  • Acute crescentic glomerulonephritis
  • Acute glomerulonephritis
  • Acute hemorrhagic glomerulonephritis
  • Acute poststreptococcal glomerulonephritis
  • Anti-basement membrane glomerulonephritis
  • Berger focal glomerulonephritis
  • Chronic glomerulonephritis
  • Diffuse glomerulonephritis
  • Exudative glomerulonephritis
  • Focal embolic glomerulonephritis
  • Focal glomerulonephritis
  • Hypocomplementemic glomerulonephritis
  • Immune complex glomerulonephritis
  • Lobular glomerulonephritis
  • Local glomerulonephritis
  • Membranoproliferative glomerulonephritis
  • Membranous glomerulonephritis
  • Mesangial proliferative glomerulonephritis
  • Mesangiocapillary glomerulonephritis
  • Proliferative glomerulonephritis
  • Rapidly progressive glomerulonephritis
  • Segmental glomerulonephritis
  • Subacute glomerulonephritis
Each of your kidneys contains approximately 1 million tiny filters (glomeruli), which attach to the opening of a small fluid-collecting tube (tubule). Each glomerulus and tubule form a nephron, the functional unit of the kidneys. The glomeruli filter your blood as it passes through your kidneys, and the filtered blood returns to your bloodstream. The tubules modify what the glomeruli filter by saving needed substances, such as protein. The waste goes to your bladder as urine through a tube (ureter) from each kidney and passes out of your body when you urinate.Glomerulonephritis — an inflammation of the glomeruli — can damage your kidneys so that they lose their filtering ability, allowing dangerous levels of fluid and waste to accumulate in your body (called kidney failure) and depriving your bloodstream of protein, which is excreted in your urine.Doctors divide glomerulonephritis into different types, depending on the cause of the illness, its symptoms and the kind of urine problems it causes. Three examples of these types are:
  • Acute postinfectious it: This form of this follows an infection and often causes high blood pressure, dark urine, water retention and swelling because of kidney failure.
  • Mesangial glomerulonephritis: This type seems to be related to immune-system abnormalities involving a type of antibody called immunoglobulin A (IgA). In most cases, the cause of this immune problem is not known, though it may be associated with a number of conditions, including cirrhosis of the liver, celiac disease (also called gluten enteropathy, celiac sprue or non-tropical sprue) and HIV infection. It can cause red blood cells to spill into the urine, but rarely causes high blood pressure, leg swelling or kidney failure.
  • Membranous glomerulonephritis: In this disease, the glomeruli leak large amounts of protein into the urine from the blood.
How long this lasts depends on its cause and on the severity of kidney damage. When it follows an infection, the problem usually goes away within weeks to months. In other cases, it becomes a chronic (long-lasting) condition that lasts for years and eventually can lead to renal failure.Symptoms:The following are the most common symptoms. However, each child may experience symptoms differently. Symptoms may include:
  • Dark brown-colored urine (from blood and protein).
  • Sore throat.
  • Diminished urine output.
  • Fatigue.
  • Lethargy.
  • Increased breathing effort.
  • Headache.
  • High blood pressure.
  • Seizures (may occur as a result of high blood pressure).
  • Rash, especially over the buttocks and legs.
  • Weight loss.
  • Joint pain.
  • Pale skin color.
  • Fluid accumulation in the tissues (edema).
The symptoms of glomerulonephritis may resemble other conditions and medical problems.Causes and Risk factors:The cause of glomerulonephritis is unknown. Known causes include:
  1. The most common cause is postinfectious Streptococcus species (ie, group A, beta-hemolytic). Two types have been described as (1) attributed to serotype 12, poststreptococcal nephritis due to an upper respiratory infection occurring primarily in the winter months, and (2) attributed to serotype 49, poststreptococcal nephritis due to a skin infection usually observed in the summer and fall and more prevalent in southern regions of the United States.
  2. Other specific agents include viruses and parasites, systemic and renal disease, visceral abscesses, endocarditis, infected grafts or shunts, and pneumonia.
  3. Bacterial causes other than group A streptococci may be diplococcal, streptococcal, staphylococcal, or mycobacterial. Salmonella typhosa, Brucella suis, Treponema pallidum, Corynebacterium bovis, and actinobacilli have also been identified.
  4. Cytomegalovirus, coxsackievirus, Epstein-Barr virus, hepatitis B, rubella, rickettsial scrub typhus, and mumps are accepted as viral causes only if it can be documented that a recent group A beta-hemolytic streptococcal infection did not occur.
  5. Fungal and parasitic: Attributing to a parasitic or fungal etiology requires the exclusion of a streptococcal infection. Identified organisms include Coccidioides immitis and the following parasites: Plasmodium malariae, Plasmodium falciparum, Schistosoma mansoni, Toxoplasma gondii, filariasis, trichinosis, and trypanosomes.
Risk Factors:
  • Post-streptococcal glomerulonephritis: It may develop after a strep infection in your throat or, rarely, on your skin (impetigo). Post-infectious glomerulonephritis is becoming less common in the United States, most likely because of rapid and complete antibiotic treatment of most streptococcal infections.
  • Bacterial endocarditis: Bacteria can occasionally spread through your bloodstream and lodge in your heart, causing an infection of one or more of your heart valves. Those at greatest risk are people with a heart defect, such as a damaged or artificial heart valve.
  • Viral infections: Among the viral infections that may trigger glomerulonephritis are the human immunodeficiency virus (HIV), which causes AIDS, and the hepatitis B and hepatitis C viruses, which primarily affect the liver.
  • Lupus: A chronic inflammatory disease, lupus can affect many parts of your body, including your skin, joints, kidneys, blood cells, heart and lungs.
  • Goodpasture's syndrome: A rare immune lung disorder that may mimic pneumonia, Goodpasture's syndrome causes bleeding (hemorrhage) into your lungs as well as glomerulonephritis.
  • IgA nephropathy: Characterized by recurrent episodes of blood in the urine, this primary glomerular disease results from deposits of immunoglobulin A (IgA) in the glomeruli. IgA nephropathy can progress for years with no noticeable symptoms. The disorder seems to be more common in men than in women.
  • Polyarteritis: This form of vasculitis affects small and medium blood vessels in many parts of your body, such as your heart, kidneys and intestines.
  • Wegener's granulomatosis: This form of vasculitis affects small and medium blood vessels in your lungs, upper airways and kidneys.
  • High blood pressure: Damage to your kidneys and their ability to perform their normal functions can occur as a result of high blood pressure. It can also cause high blood pressure because it reduces kidney function.
  • Diabetic kidney disease: Diabetic kidney disease (diabetic nephropathy) can affect anyone with diabetes. Diabetic nephropathy usually takes years to develop. Good control of blood sugar levels and blood pressure may prevent or slow kidney damage.
  • Focal segmental glomerulosclerosis: Characterized by scattered scarring of some of the glomeruli, this condition may result from another disease or occur for no known reason.
Diagnosis:In addition to a thorough physical examination and complete medical history, your child's physician may recommend the following diagnostic tests:Throat culture:
  • The primary purpose of a throat culture is identification of the specific organisms that cause strep throat. These organisms are Group A streptococci, specifically Streptococcus pyogenes. Since most sore throats are caused by viral infections rather than by S. pyogenes, a correct diagnosis is important to prevent unnecessary use of antibiotics and to begin treatment of strep infections as soon as possible. Group A streptococcal infections are potentially life-threatening, often involving other parts of the body in addition to the throat. Besides causing sore throat (pharyngitis), streptococci can also cause scarlet fever, rheumatic fever, kidney disease, or abscesses around the tonsils.
  • Throat cultures can also be used to identify other disease organisms that are present in the patient's throat; and to identify people who are carriers of the organisms that cause meningitis and whooping cough.
Urine tests: This test can measure:
  • Urine is dark.
  • Specific gravity is greater than 1020 osm.
  • Proteinuria is observed.
  • RBCs and red cell casts are present.
  • Although not indicated in the ED setting, a 24-hour urine protein excretion and creatinine clearance may be helpful to document the degree of renal dysfunction and proteinuria.
Blood tests:
  • Complete blood cell count.
  • A decrease in hematocrit may demonstrate a dilutional anemia.
  • In the setting of an infectious etiology, pleocytosis may be evident.
  • Electrolytes, including BUN and creatinine (to estimate the glomerular filtration rate [GFR]): The BUN and creatinine levels will exhibit a degree of renal compromise
Electrocardiogram (ECG or EKG) - a test that records the electrical activity of the heart, shows abnormal rhythms (arrhythmias or dysrhythmias), and detects heart muscle damage.Renal ultrasound (Also called sonography.) - a non-invasive test in which a transducer is passed over the kidney producing sound waves which bounce off of the kidney, transmitting a picture of the organ on a video screen. The test is used to determine the size and shape of the kidney, and to detect a mass, kidney stone, cyst, or other obstruction or abnormalities.Chest x-ray - a diagnostic test which uses invisible electromagnetic energy beams to produce images of internal tissues, bones, and organs onto film.Renal biopsy - a procedure where a small sample of tissue is taken from the kidney through a needle. The tissue is sent for special testing to determine the specific disease.Treatment:When glomerulonephritis is caused by an infection, the first step in treatment is to eliminate the infection. If bacteria caused the infection, antibiotics may be given. However, children who develop the disease following a streptococcal infection often recover without any specific treatment.When glomerulonephritis has slowed the amount of urine a person is producing, he or she may be given medications called diuretics, which help the body to rid itself of excess water and salt by producing more urine. More severe forms of the disease are treated with medications to control high blood pressure, as well as changes in diet to reduce the work of the kidneys. A small percentage of people with severe glomerulonephritis may be treated with medications called immunosuppressive drugs, which decrease the activity of the immune system, such as corticosteroids and/or cyclophosphamide (Cytoxan). If glomerulonephritis progresses to end-stage renal failure, treatment options include dialysis and a kidney transplant.Medicine and medications:The following drugs and medications are in some way related to, or used in the treatment. This service should be used as a supplement to, and NOT a substitute for, the expertise, skill, knowledge and judgment of healthcare practitioners.Related Medications Include:
  • Penicillin V (Veetids).
  • Labetalol (Normodyne).
  • Furosemide (Lasix).
  • Methylprednisolone (used for nonstreptococcal etiologies of acute glomerulonephritis, particularly in lupus nephritis and in idiopathic progressive glomerulonephritis).
  • Cyclophosphamide (is used for etiology-dependent treatment of acute glomerulonephritis due to Wegener granulomatosis).
DISCLAIMER: This information should not substitute for seeking responsible, professional medical care. 

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