Chronic glomerulonephritis Definition

Chronic glomerulonephritis is the advanced stage of a group of kidney disorders, resulting in inflammation and slowly worsening destruction of internal kidney structures called glomeruli.

Alternative Names
Glomerulonephritis - chronic; Chronic nephritis

Causes
Chronic glomerulonephritis occurs when there is slow, progressive destruction of the glomeruli of the kidney, with progressive loss of kidney function. In some cases, the cause is found to be a specific attack to the body's immune system, but in most cases, the cause is unknown. Iit is generally thought that a stillunidentified abnormality of the immune system is to blame. Damage to the glomeruli affects the kidney's ability to filter fluids and wastes properly. This leads to blood and protein in the urine. This condition may develop after survival of the acutephase of rapidly progressive glomerulonephritis. In about one-quarter of people with chronic glomerulonephritis there is no prior history of kidney disease, and the disorder first appears as chronic kidney failure. Glomerulonephritis is among the leading causes of chronic kidney failure and end stage kidney disease. Causes include:

Diabetic nephropathy/sclerosis Focal segmental glomerulosclerosis IgA nephropathy (Berger's disease) Lupus nephritis Membranous glomerulonephritis Mesangial proliferative disorder Nephritis associated with disorders such as amyloidosis, multiple myeloma, or immune disorders, including AIDS

Symptoms
This condition causes high blood pressure (hypertension) and chronic kidney failure. Specific symptoms include:

Blood in the urine (dark, rust-colored, or brown urine) Foamy urine

Chronic kidney failure symptoms that gradually develop may include the following:

Decreased alertness o Drowsiness, somnolence, lethargy o Confusion, delirium o Coma Decreased sensation in the hands, feet, or other areas

Decreased urine output Easy bruising or bleeding Fatigue Frequent hiccups General ill feeling (malaise) Generalized itching Headache Increased skin pigmentation -- skin may appear yellow or brown Muscle cramps Muscle twitching Nausea and vomiting Need to urinate at night Seizures Unintentional weight loss

Additional symptoms that may be associated with this disease:

Blood in the vomit or stools Excessive urination High blood pressure Nosebleed

Exams and Tests

Because symptoms develop gradually, the disorder may be discovered when there is an abnormal urinalysis during a routine physical or during an examination for another, unrelated disorder. It may be discovered as a cause of high blood pressure that is difficult to control. Laboratory tests may reveal anemia or show signs of reduced kidney functioning, includingazotemia. Later, signs of chronic kidney failure may be apparent, including edema . Tests that may be done include:

Chest x-ray Kidney or abdominal CT scan Kidney or abdominal ultrasound IVP Urinalysis

A kidney biopsy may show one of the forms of chronic glomerulonephritis or scarring of the glomeruli. This disease may also alter the results of the following tests:

Albumin Abdominal MRI Anti-glomerular basement membrane BUN Complement component 3 Complement Creatinine clearance Renal scan Total protein Uric acid, urine

Urine Urine Urine Urine Urine

concentration test creatinine RBC specific gravity protein

Treatment
Treatment varies depending on the cause of the disorder, and the type and severity of symptoms. The primary treatment goal is control of symptoms. High blood pressure may be difficult to control, and it is generally the most important aspect of treatment. Various medications may be used to attempt to control high blood pressure. Corticosteroids, immunosuppressives, or other medications may be used to treat some of the causes of chronic glomerulonephritis. Dietary restrictions on salt, fluids, protein, and other substances may be recommended to help control of high blood pressure or kidney failure. Dialysis or kidney transplantation may be necessary to control symptoms of kidney failure and to sustain life.

Support Groups
For information and support, see kidney disease support groups.

Outlook (Prognosis)
The outcome varies depending on the cause. Some types of glomerulonephritis may get better on their own. If nephrotic syndrome is present and can be controlled, other symptoms may be controlled. If nephrotic syndrome is present and cannot be controlled, end-stage kidney disease is likely. The disorder worsens at widely variable rates.

Possible Complications

Nephrotic syndrome Acute nephritic syndrome Chronic renal failure End-stage renal disease Hypertension Malignant hypertension Fluid overload -- congestive heart failure, pulmonary edema Chronic or recurrent urinary tract infection Increased susceptibility to other infections

When to Contact a Medical Professional

Call your health care provider if disorders associated with increased risk of chronic glomerulonephritis are present, or if symptoms indicating glomerulonephritis develop.

Prevention

There is no specific prevention for most cases of chronic glomerulonephritis. Some cases may be prevented by avoiding or limiting exposure to organic solvents, mercury, and nonsteroidal anti-inflammatory analgesics.

Statistics on Glomerulonephritis
Primary:

Minimal change glomerulopathy - early childhood (mostly 1-6yo). Acute post-streptococcal glomerulonephritis - sporadically or endemic. Sporadic is more common and affects children more than adults with the peak incidence from age 2-6.

Anit-glomerular basement membrane glomerulonephritis - 20% of rapidly progressive glomerulonephritis and probably less than 1% of all diagnostic biopsies.

IgA nephrophathy - very common in many countries (20-25% of all glomerulonephritis in Southern Europe and Australia and 3040% in Japan and Singapore).

Mebranoproliferative glomerulonephritis - uncommon. The frequencies of the associated disorders vary widely. Diabetic nephropathy is a common cause of nephrotic syndrome in the adult, lupus nephritis is moderately common in young women but the majority of the disorders are quite rare.

Glomerulonephritis (GN) is a disease condition where immunologic mechanisms trigger inflammation of the glomerulus as well as the proliferation of glomerular tissue resulting into basement membrane, mesangium, and capillary endothelium damage (Papanagnou, 2008). Etiologies may vary, however, majority of the cases are idiopathic while one of the known causes of GN include infection (such as that of streptococcal infection [Pais, Kump, & Greenbaum, 2008]). Because of this, clinical manifestations of patients with GN include hematuria, proteinuria and RBC casts which may be accompanied by azotemia, oliguria, and decreased GFR (glomerular filtration rate). For definitive diagnosis, Renal Biopsy is required as it is also used to diagnose several renal problems (Papanagnou, 2008; & Fuiano, et. al, 2001). Patients who are candidates for renal biopsy are those with individual, or familial history of renal disease, as well as patients with atypical presentation (includes proteinuria, nephritic syndrome, or a rapid rise in the level of creatinine without resolution). Fuiano, et.al (2001), mentioned that when patients are presenting with signs and symptoms of renal insufficiency, renal biopsy establishes a pathologic diagnosis. Certain considerations are however taken into account such as the kidney size or the extent of kidney insufficiency prior to undergoing a renal biopsy. As for patients with severe chronic insufficiency, undergoing this procedure poses additional complications and seems futile as this would not effect management of the condition. But for mild to moderate renal insufficiency, the procedure may identify the causes of the problem and may alter the treatment course. For acute renal insufficiency, biopsy still remains important. IgA nephropathy (IgAN) was the most common glomerulonephritis at renal biopsy in a study conducted by Coppo, Gianoglio, Porcellini, and Maringhini (1998). As createnine concentration is the most common biomarker to predict the level of GFR (in effect, kidney function), it is used therefore to determine the severity of the disease condition. Obrenovic, et.al (2006) highlighted in there research study that there are certain limitations that interfere with the result of using createnine as biomarker. Factors include age, gender, muscle mass, diet, and drug use. In the same experimental study, the researchers explored on the relationship of proteinuria on crystatin C concentration in patients with GN. Lhee, et.al (2006) conducted a study on whether Neopterin can serve as an indicator of the disease activity and as a prognostic measure same as other clinical parameters including BUN, createnine levels and serum albumin). Neopterin is a serum and urine marker produced by guanosine triphosphate (GTP), and is synthesized by the macrophages and when T cells are active

during immunologic processes. In GN, there are more males acquiring the condition with a ratio of 2:1. This particularly afflicts children and young adolescents, (5-15 years of age) while a smaller portion, 10% occur in patients above 40 years. It may however be acquired at any time in the lifespan. Statistics of GN in the United States would reveal that of the glomerular disease, there is 10-15% representation of GN. (Papanagnou, 2008). Immunoglobulin A (IgA) nephropathy GN is the most common cause of GN worldwide. While there had been reduction in the incidence of poststreptococal GN in majority of western countries, it remains much more common in regions such as Africa, the Caribbean, India, Pakistan, Malaysia, Papua New Guinea, and South America. Because assessment is the first phase and is of basic importance in the nursing process, researches related to assessment of patients with GN have direct impact on the care provided by nurses. Baseline data are further strengthened by such researches as above and provides a clearer understanding of the case scenario and that of the pathophysiologic process of GN. It is therefore imperative for nurses to update themselves regarding updates brought about by scholarly made researches and evidence-based researches.