What Is Glomerulonephritis?

Glomerulonephritis (pronounced gluh-mare-you-low-nih-fry-tis), is a group of diseases that injure the part of the kidney that filters blood (called glomeruli). Other terms you may hear used are nephritis and nephrotic syndrome. When the kidney is injured, it cannot get rid of wastes and extra fluid in the body. If the illness continues, the kidneys may stop working completely, resulting in kidney failure.

Glomerulonephritis makes it hard for the kidneys to work as they should. This commonly results in the loss of protein out of the blood, and both red and white blood cells in addition to protein may leak into the urine. Some people with glomerulonephritis will lose their ability to filter waste and many will retain fluid. Eventually, some people with glomerulonephritis may develop chronic kidney disease (CKD) or end stage renal disease (ESRD) and have to begin a renal replacement therapy such as dialysis.

Are there different types of glomerulonephritis?

Yes. There are two types of glomerulonephritis — acute and chronic. The acute form develops suddenly. You may get it after an infection in your throat or on your skin. Sometimes, you may get better on your own. Other times, your kidneys may stop working unless the right treatment is started quickly. The early symptoms of the acute disease are:

puffiness of your face in the morning
blood in your urine (or brown urine)
urinating less than usual.

You may be short of breath and cough because of extra fluid in your lungs. You may also have high blood pressure. If you have one or all of these symptoms, be sure to see your doctor right away.

The chronic form may develop silently (without symptoms) over several years. It often leads to complete kidney failure. Early signs and symptoms of the chronic form may include:

Blood or protein in the urine (hematuria, proteinuria)
High blood pressure
Swelling of your ankles or face (edema)
Frequent nighttime urination
Very bubbly or foamy urine

Symptoms of kidney failure include:

Lack of appetite
Nausea and vomiting
Tiredness
Difficulty sleeping
Dry and itchy skin
Nighttime muscle cramps

What causes acute glomerulonephritis?

The acute disease may be caused by infections such as strep throat. It may also be caused by other illnesses, including lupus, Goodpasture’s syndrome, Wegener’s disease, and polyarteritis nodosa. Early diagnosis and prompt treatment are important to prevent kidney failure.

What causes chronic glomerulonephritis?

Sometimes, the disease runs in the family. This kind often shows up in young men who may also have hearing loss and vision loss. Some forms are caused by changes in the immune system. However, in many cases, the cause is not known. Sometimes, you will have one acute attack of the disease and develop the chronic form years later.

Other disorders that can cause glomerulonephritis include:

Focal segmental glomerulosclerosis
Scar tissue forms in the filtering units of the kidneys or glomeruli, making it hard for the kidneys to function like they should.
Diabetes
A disease that affects your body’s ability to produce or use insulin and the most common cause of kidney failure.
Goodpasture’s syndrome
An autoimmune disorder that affects the kidneys and lungs, often leading to kidney failure and lung disease.
IgA nephropathy (Berger’s disease)
A kidney disease caused by inflammation of the glomeruli that causes blood in the urine.
Membranoproliferative GN I (MPGN I)
A kidney disorder marked by inflammation and changes in the structure of the kidney cells.
Membranoproliferative GN II(MPGN II or dense deposit)
A disease marked by deposits that build up in the kidneys and scar them so they are unable to function properly.
Post-streptococcal GN
A kidney disorder that happens after someone is infected with certain kinds of streptococcus bacteria, the bacteria that cause strep throat or skin infections.

Symptoms of glomerulonephritis

Chronic glomuerulonephritis often causes mild symptoms that may not even be noticed for a while. However, as the disease progresses and causes the kidneys to fail, symptoms may grow worse.

Symptoms include:

Swollen feet and legs
Puffy face and eyes
Decrease in urine production
Bubbly, cloudy or bloody urine
Nausea
Shortness of breath
Weakness
Fatigue
Fever
Hypertension
Loss of appetite
Abdominal pain
Headaches
Visual disturbances
Seizures

Diagnosing glomerulonephritis

The first clues are the signs and symptoms. Finding protein and blood cells in your urine is another sign. Blood tests will help the doctor tell what type of illness you have and how much it has hurt your kidneys.

In some cases, a test called a kidney biopsy may be needed. In this test, a tiny piece of your kidney is removed with a special needle, and looked at under a microscope. A biopsy will help the doctor plan the best treatment for you.

There are various ways to diagnose glomerulonephritis:

During a routine check-up or exam
Testing that links to specific symptoms
Blood or urine test
Image scan of the kidneys
Kidney biopsy

Can glomerulonephritis be prevented?

Not until more is known about its causes. However, good hygiene, practicing “safe sex” and avoiding IV drugs are helpful in preventing viral infections such as HIV and hepatitis, which could lead to this illness.

If you have the chronic type of glomerulonephritis, it is very important to control your blood pressure since this may slow down kidney damage. Your doctor may tell you to eat less protein. A dietitian trained to work with kidney patients (a renal dietitian) can be very helpful in planning your diet.

Treating glomerulonephritis

The acute form may go away by itself. Sometimes you may need medication or even temporary treatment with an artificial kidney machine to remove extra fluid and control high blood pressure and kidney failure. Antibiotics are not used for acute glomerulonephritis, but they are important in treating other forms of disease related to bacterial infection. If your illness is getting worse rapidly, you may be put on high doses of medicine that affect your immune system. Sometimes, your doctor may order plasmapheresis, a special blood filtering process to remove harmful proteins from your blood.

There is no specific treatment for the chronic form of the illness. You doctor may tell you to:

Eat less protein, salt and potassium
Control your blood pressure
Take diuretics (water pills) to treat puffiness and swelling
Take calcium supplements

Recovery from glomerulonephritis has to do with the cause of the disease, the person’s age and any other health conditions he or she may have. A kidney transplant may be a viable treatment option for someone with glomerulonephritis whose kidneys have failed, but the disease could return in a transplanted kidney. Dialysis is another option for someone with failed kidneys.

What is nephrotic syndrome?

Nephrotic syndrome (also called nephrosis) happens when your kidneys start losing large amounts of protein in your urine. As your kidneys get worse, extra fluids and salt build up in your body. This causes you to have swelling (edema), high blood pressure and higher levels of cholesterol. Nephrotic syndrome may come from kidney diseases or from other illnesses such as diabetes and lupus. Some medicines, IV drug abuse and HIV (the AIDS virus) may also cause it. Sometimes, nephrotic syndrome goes away after treatment. Other times, this condition may last for many years and eventually lead to kidney failure.

What treatment is available for nephrotic syndrome?

Your doctor may prescribe corticosteroids, such as prednisone. If prednisone does not work, your doctor may suggest other medicines that affect your immune system, such as cyclophosphamide.

Your doctor may also suggest: