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Glomerulonephritis

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Glomerulonephritis
Classification and external resources
Photomicrograph of a kidney biopsy from a patient with crescentic glomerulonephr
itis showing prominent fibrocellular crescent formation and moderate mesangial p
roliferation in a glomerulus. Hematoxylin and eosin stain.
ICD-10 N00, N01, N03, N18
ICD-9 580-582
DiseasesDB 5245
MeSH D005921
Glomerulonephritis, also known as glomerular nephritis, abbreviated GN, is a ren
al disease characterized by inflammation of the glomeruli, or small blood vessel
s in the kidneys.[1] It may present with isolated hematuria and/or proteinuria (
blood resp. protein in the urine); or as a nephrotic syndrome, a nephritic syndr
ome, acute renal failure, or chronic renal failure. They are categorised into se
veral different pathological patterns, which are broadly grouped into non-prolif
erative or proliferative types. Diagnosing the pattern of GN is important becaus
e the outcome and treatment differs in different types. Primary causes are ones
which are intrinsic to the kidney, whilst secondary causes are associated with c
ertain infections (bacterial, viral or parasitic pathogens), drugs, systemic dis
orders (SLE, vasculitis) or diabetes.
Contents
[hide]
* 1 Thin Basement Membrane Disease
* 2 Non Proliferative
o 2.1 Minimal change GN (also known as Minimal Change Disease)
o 2.2 Focal Segmental Glomerulosclerosis (FSGS)
o 2.3 Membranous glomerulonephritis
* 3 Proliferative
o 3.1 IgA nephropathy (Berger's disease)
o 3.2 Post-infectious
o 3.3 Membranoproliferative/mesangiocapillary GN
o 3.4 Rapidly progressive glomerulonephritis
* 4 See also
* 5 References
[edit] Thin Basement Membrane Disease
Thin basement membrane disease is an autosomal dominant inherited disease charac
terized by thin glomerular basement membranes on electron microscopy. It is a be
nign condition that causes persistent microscopic haematuria.
[edit] Non Proliferative
This is characterised by the numbers of cells (lack of hypercellularity) in the
glomeruli. They usually cause nephrotic syndrome. This includes the following ty
pes:
[edit] Minimal change GN (also known as Minimal Change Disease)
This form of GN causes 80% of nephrotic syndrome in children, but only 20% in ad
ults. As the name indicates, there are no changes visible on simple light micros
copy, but on electron microscopy there is fusion of podocytes (supportive cells
in the glomerulus). Immunohistochemistry staining is negative. Treatment consist
s of supportive care for the massive fluid accumulation in the patients body (=
oedema) and as well as steroids to halt the disease process (typically Prednison
e 1 mg/kg). Over 90% of children respond well to steroids, being essentially cur
ed after 3 months of treatment. Adults have a lower response rate (80%). Failure
to respond to steroids ('steroid resistant') or return of the disease when ster
oids are stopped ('steroid dependent') may require cytotoxic therapy (such as ci
closporin) which is associated with many side-effects.
[edit] Focal Segmental Glomerulosclerosis (FSGS)
FSGS may be primary or secondary to reflux nephropathy, Alport syndrome, heroin
abuse or HIV. FSGS presents as a nephrotic syndrome with varying degrees of impa
ired renal function (seen as a rising serum creatinine, hypertension). As the na
me suggests, only certain foci of glomeruli within the kidney are affected, and
then only a segment of an individual glomerulus. The pathological lesion is scle
rosis (fibrosis) within the glomerulus and hyalinisation of the feeding arteriol
es, but no increase in the number of cells (hence non-proliferative). The hyalin
e is an amorphous material, pink, homogeneous, resulting from combination of pla
sma proteins, increased mesangial matrix and collagen. Staining for antibodies a
nd complement is essentially negative. Steroids are often tried but not shown to
be effective. 50% of people with FSGS continue to have progressive deterioratio
n of kidney function, ending in renal failure.
[edit] Membranous glomerulonephritis
Membranous glomerulonephritis (MGN), a relatively common type of glomerulonephri
tis in adults, frequently produces a mixed nephrotic and nephritic picture. It i
s usually idiopathic, but may be associated with cancers of the lung and bowel,
infection such as hepatitis and malaria, drugs including penicillamine, and conn
ective tissue diseases such as systemic lupus erythematosus. Individuals with ce
rebral shunts are at risk of developing shunt nephritis, which frequently produc
es MGN.
Microscopically, MGN is characterized by a thickened glomerular basement membran
e without a hypercellular glomerulus. Immunofluorescence demonstrates diffuse gr
anular uptake of IgG. The basement membrane may completely surround the granular
deposits, forming a "spike and dome" pattern. Tubules also display the symptoms
of a typical Type VI hypersensitivity reaction, which causes the endothelial ce
lls to proliferate, which can be seen under a light microscope with a PAS stain[
2].[3]
Prognosis follows the rule of thirds: one-third remain with MGN indefinitely, on
e-third remit, and one-third progress to end-stage renal failure. As the glomeru
lonephritis progresses, the tubules of the kidney become infected, leading to at
rophy and hyalinisation. The kidney appears to shrink. Treatment with corticoste
roids is attempted if the disease progresses.
In extremely rare cases, the disease has been known to run in families, usually
passed down though the females. This condition, similarliy is called Familial Me
mbranous Glomerulonephritis. There have only been about nine documented cases in
the world.
[edit] Proliferative
This type is characterised by increased number of cells in the glomerulus (hyper
cellular). Usually present as a nephritic syndrome and usually progress to end-s
tage renal failure (ESRF) over weeks to years (depending on type).
[edit] IgA nephropathy (Berger's disease)
IgA nephropathy is the most common type of glomerulonephritis in adults worldwid
e. It usually presents as macroscopic haematuria (visibly bloody urine). It occa
sionally presents as a nephrotic syndrome. It often affects young males within d
ays (24-48hrs) after an upper respiratory tract or gastrointestinal infection. M
icroscopic examination of biopsy specimens shows increased number of mesangial c
ells with increased matrix (the 'cement' which holds everything together). Immun
o-staining is positive for immunoglobulin A deposits within the matrix. Prognosi
s is variable, 20% progress to ESRF. ACE inhibitors are the mainstay of treatmen
t.
[edit] Post-infectious
Post-infectious glomerulonephritis can occur after essentially any infection, bu
t classically occurs after infection with Streptococcus pyogenes. It typically o
ccurs 10 14 days after a skin or pharyngeal infection with this bacterium.
Patients present with signs and symptoms of glomerulonephritis. Diagnosis is mad
e based on these findings in an individual with a history of recent streptococca
l infection. Streptococcal titers in the blood (antistreptolysin O titers) may s
upport the diagnosis.
Light microscopy demonstrates diffuse endocapillary hypercellularity due to prol
iferation of endothelial and mesangial cells, as well as an influx of neutrophil
s and monocytes. The Bowman space is compressed, in some cases to the extent tha
t this produces a crescent formation characteristic of crescentic glomerulonephr
itis.
Biopsy is seldom done as the disease usually regresses without complications. Tr
eatment is supportive, and the disease generally resolves in 2 4 weeks.
[edit] Membranoproliferative/mesangiocapillary GN
This is primary, or secondary to SLE, viral hepatitis, hypocomplementemia. One s
ees 'hypercellular and hyperlobular' glomeruli due to proliferation of both cell
s and the matrix within the mesangium. Presents usually with a combined nephriti
c-nephrotic picture, with inevitable progression to end stage renal failure.
[edit] Rapidly progressive glomerulonephritis
Crescentic glomerulonephritis induced by infective endocarditis on PAS staining
and immunofluorescence. PAS staining (left) demonstrated circumferential and cel
lular crescent formation with interstitial nephritis. Immunofluorescence (right)
demonstrated C3 positive staining in mesangial area.
Photomicrograph of renal biopsy showing crescent formation and tuft narrowing. P
eriodic acid silver methenamine stain.
Rapidly progressive glomerulonephritis (Crescentic GN) has a poor prognosis, wit
h rapid progression to kidney failure over weeks. Steroid therapy is sometimes u
sed.[4] Any of the above types of GN can be rapidly progressive. Additionally tw
o further causes present as solely RPGN.
* One is Goodpasture's syndrome, an autoimmune disease whereby antibodies ar
e directed against basal membrane antigens found in the kidney and lungs. As wel
l as kidney failure, patient have hemoptysis (cough up blood). High dose immunos
uppression is required (intravenous Methylprednisolone) and cyclophosphamide, pl
us plasmapheresis. Immunohistochemistry staining of tissue specimens shows linea
r IgG deposits.
* The second cause is vasculitic disorders such as Wegener's granulomatosis
and polyarteritis. There is a lack of immune deposits on staining, but blood tes
ts are positive for ANCA antibody.
Histopathology: The majority of glomeruli present "crescents". Formation of cres
cents is initiated by passage of fibrin into the Bowman space as a result of inc
reased permeability of glomerular basement membrane. Fibrin stimulates the proli
feration of parietal cells of Bowman capsule, and an influx of monocytes. Rapid
growing and fibrosis of crescents compresses the capillary loops and decreases t
he Bowman space which leads to renal failure within weeks or months.
[edit] See also
* Nephritic syndrome
* nephritis
[edit] References
1. ^ glomerulonephritis at Dorland's Medical Dictionary
2. ^ Dr. Zaid G. Nguyen MD. University of Melbourne, Dept of Medicine
3. ^ http://www.nlm.nih.gov/medlineplus/ency/article/000472.htm
4. ^ Couser WG (May 1999). "Glomerulonephritis". Lancet 353 (9163): 1509 15. do
i:10.1016/S0140-6736(98)06195-9. PMID 10232333. http://linkinghub.elsevier.com/r
etrieve/pii/S0140-6736(98)06195-9.
[hide]
v d e
Urinary system · Pathology · Urologic disease / Uropathy (N00 N39, 580 599)
Abdominal
Nephropathy/
(nephritis+
nephrosis)
Glomerulopathy/
glomerulitis/
(glomerulonephritis+
glomerulonephrosis)
Primarily
nephrotic
Non-proliferative
.0 Minimal change · .1 Focal segmental · .2 Membranous
Proliferative
.3 Mesangial proliferative · .4 Endocapillary proliferative .5/.6 Membranoprolif
erative/mesangiocapillary
By condition
Diabetic · Amyloidosis
Primarily
nephritic,
.7 RPG
Type I RPG/Type II hypersensitivity
Goodpasture's syndrome
Type II RPG/Type III hypersensitivity
Post-streptococcal · Lupus (DPN) · IgA/Berger's
Type III RPG/Pauci-immune
Wegener's granulomatosis · Microscopic polyangiitis
Tubulopathy/
tubulitis
Proximal
RTA (RTA 2) · Fanconi syndrome
Thick ascending
Bartter syndrome
Distal convoluted
Gitelman syndrome
Collecting duct
Liddle's syndrome · RTA (RTA 1) · Diabetes insipidus (Nephrogenic)
Renal papilla
Renal papillary necrosis
Major calyx/pelvis
Hydronephrosis · Pyonephrosis · Reflux nephropathy
Any/all
Acute tubular necrosis
Interstitium
Interstitial nephritis (Pyelonephritis, Danubian endemic familial nephropathy)
Any/all
General syndromes
Renal failure (Acute renal failure, Chronic renal failure) · Uremic pericarditis
· Uremia
Vascular
Renal artery stenosis · Renal Ischemia · Hypertensive nephropathy · Renovascular
hypertension
Other
Analgesic nephropathy · Renal osteodystrophy · Nephroptosis · Abderhalden-Kaufma
nn-Lignac syndrome
Ureter
Ureteritis · Ureterocele · Megaureter
Pelvic
Bladder
Cystitis (Interstitial cystitis, Hunner's ulcer, Trigonitis, Hemorrhagic cystiti
s) · Neurogenic bladder · Bladder sphincter dyssynergia · Vesicointestinal fistu
la · Vesicoureteral reflux
Urethra
Urethritis (Non-gonococcal urethritis) · Urethral syndrome · Urethral stricture/
Meatal stenosis
Any/all
Obstructive uropathy · Urinary tract infection · Retroperitoneal fibrosis · Urol
ithiasis (Kidney stone, Renal colic) · Malacoplakia · Urinary incontinence (Stre
ss, Urge, Overflow)
M: URI

anat/phys/devp

noco/acba/cong/tumr, sysi/epon, urte

proc, dr
Glomerulonephritis
URL of this page: http://www.nlm.nih.gov/medlineplus/ency/article/000484.htm
Glomerulonephritis is a type of kidney diseasekidney disease in which the part o
f your kidneys that helps filter waste and fluids from the blood is damaged.
Causes
Causes
Glomerulonephritis may be caused by specific problems with the body's immune sys
tem. Often, the precise cause of glomerulonephritis is unknown.
Damage to the glomeruli causes blood and protein to be lost in the urine.
The condition may develop quickly, with loss of kidney function occurring over w
eeks and months (called rapidly progressive glomerulonephritis).
In about a quarter of people with chronic glomerulonephritis there is no history
of kidney diseasekidney disease and the disorder first appears as chronic renal
failure.
The following increase your risk of developing this condition:
* History of cancer
* Blood or lymphatic system disorders
* Exposure to hydrocarbon solvents
* Infections such as strep infectionsstrep infections, viruses, heart infect
ionsheart infections,or abscessesabscesses
* Diabetes
Many conditions are known to cause or increase the risk for glomerulonephritis,
including:
* Focal segmental glomerulosclerosisFocal segmental glomerulosclerosis
* Goodpasture syndromeGoodpasture syndrome
* Membranoproliferative GNMembranoproliferative GN
* IgA nephropathyIgA nephropathy
* Lupus nephritisLupus nephritis or Henoch-Schonlein purpuraHenoch-Schonlein
purpura
* Anti-glomerular basement membrane antibody diseaseAnti-glomerular basement
membrane antibody disease
* Blood vessel diseases such as vasculitis or polyarteritispolyarteritis
* Amyloidosis
Symptoms
Symptoms
Common symptoms of glomerulonephritis are:
* Blood in the urineBlood in the urine (dark, rust-colored, or brown urine)
* Foamy urine
* Swelling (edema) of the face, eyes, ankles, feet, legs, or abdomen
Symptoms that may also appear include the following:
* Abdominal painAbdominal pain
* Cough
* Diarrhea
* General ill feelingGeneral ill feeling
* Fever
* Joint aches
* Muscle aches
* Loss of appetite
* Shortness of breath
Chronic renal failureChronic renal failure symptoms may gradually develop.
Other symptoms that may occur with this disease:
* Excessive urinationExcessive urination
* NosebleedNosebleed
* Blood in the vomitBlood in the vomit or in stools
Exams and Tests
Exams and Tests
Because symptoms develop gradually, the disorder may be discovered when there is
an abnormal urinalysisurinalysis during a routine physical or examination for u
nrelated disorders.
Glomerulonephritis can cause high blood pressure. It may only be discovered as a
cause of high blood pressure that is difficult to control.
Laboratory tests may reveal anemiaanemia or show signs of reduced kidney functio
ning. A kidney biopsykidney biopsy confirms the diagnosis.
Later, signs of chronic kidney failure may be seen, including swelling (edemaede
ma), polyneuropathy, and signs of fluid overload, including abnormal heart and l
ung sounds.
Imaging tests that may be done include:
* Abdominal CT scanAbdominal CT scan
* Abdominal ultrasoundAbdominal ultrasound
* Chest x-rayChest x-ray
* IVPIVP
Urinalysis and other urine tests include:
* Examination of the urine under a microscope
* Creatinine clearanceCreatinine clearance
* Total proteinTotal protein
* Uric acid, urineUric acid, urine
* Urine concentration testUrine concentration test
* Urine creatinineUrine creatinine
* Urine proteinUrine protein
* Urine RBCUrine RBC
* Urine specific gravityUrine specific gravity
This disease may also affect the results of the following blood tests:
* AlbuminAlbumin
* Anti-glomerular basement membraneAnti-glomerular basement membrane antibod
y test
* Anti-neutrophil cytoplasmic antibodies (ANCAs)
* BUNBUN and creatininecreatinine
* Complement component 3Complement component 3
* ComplementComplement levels
Treatment
Treatment
Treatment varies depending on the cause of the disorder, and the type and severi
ty of symptoms. High blood pressure may be difficult to control, and it is gener
ally the most important aspect of treatment.
Medicines that may be prescribed include:
* Blood pressure medications are often needed to control high blood pressure
. Angiotensin-converting enzyme inhibitors and angiotensin receptor blockers are
most commonly prescribed.
* Corticosteroids may relieve symptoms in some cases.
* Medications that suppress the immune system may also be prescribed, depend
ing on the cause of the condition.
A procedure called plasmapheresis may be used for some cases of glomerulonephrit
is due to immune-related causes. The fluid part of the blood containing antibodi
es is removed and replaced with intravenous fluids or donated plasma (without an
tibodies). Removing antibodies may reduce inflammation in the kidney tissues.
Dietary restrictions on salt, fluids, proteinprotein, and other substances may b
e recommended.
Persons with this condition should be closely watched for signs that they are de
veloping kidney failure. Dialysis or a kidney transplant may eventually be neces
sary.
Support Groups
Support Groups
You can often ease the stress of illness by joining support groups where members
share common experiences and problems.
See: Kidney disease - support groupKidney disease - support group
Outlook (Prognosis)
Outlook (Prognosis)
Glomerulonephritis may be a temporary and reversible condition, or it may get wo
rse. Progressive glomerulonephritis may lead to chronic kidney failurechronic ki
dney failure and end-stage kidney diseaseend-stage kidney disease.
If you have nephrotic syndrome and it can be controlled, other symptoms may also
be controlled. If it can't be controlled, end-stage kidney disease may result.
Possible Complications
Possible Complications
* Nephrotic syndromeNephrotic syndrome
* Acute nephritic syndromeAcute nephritic syndrome
* Chronic kidney failure
* End-stage kidney disease
* HypertensionHypertension
* Malignant hypertensionMalignant hypertension
* Fluid overload -- congestive heart failureheart failure, pulmonary edemapu
lmonary edema
* Chronic or recurrent urinary tract infectionChronic or recurrent urinary t
ract infection
* Increased susceptibility to other infections
* HyperkalemiaHyperkalemia
When to Contact a Medical Professional
When to Contact a Medical Professional
Call your health care provider if:
* You have disorders that are associated with an increased risk of glomerulo
nephritis
* You develop symptoms of glomerulonephritis
Prevention
Prevention
There is no specific way to prevent most cases of glomerulonephritis. Some cases
may be prevented by avoiding or limiting exposure to organic solvents, mercurym
ercury, and nonsteroidal anti-inflammatory drugs (NSAIDs).
Alternative Names
Alternative Names
Glomerulonephritis - chronic; Chronic nephritis; Glomerular disease; Necrotizing
glomerulonephritis; Glomerulonephritis - crescentic; Crescentic glomerulonephri
tis; Rapidly progressive glomerulonephritis
Kidney cross section
Illustration showing kidney cross section
All your blood flows through your kidneys, which are the key organs in the compl
ex system that removes excess fluid and waste material from the blood. Blood tha
t flows into your kidneys is diffused through filtering structures called nephro
ns. Each nephron contains a tuft of capillary blood vessels (glomerulus) and tin
y tubules that lead to larger collecting tubes. The glomeruli filter fluid from
your blood, extracting both waste products and substances your body needs sodium
, phosphorus and potassium. The substances your body needs are reabsorbed into y
our bloodstream. The rest is excreted in your urine through tubules that lead in
to the ureters the tubes that lead to the bladder.
Definition
By Mayo Clinic staff
CLICK TO ENLARGE
Illustration showing kidney cross section Kidney cross section
Glomerulonephritis (glo-mer-u-lo-nuh-FRI-tis) is a type of kidney disease that d
amages your kidneys' ability to remove waste and excess fluids. Also called glom
erular disease, glomerulonephritis can be acute a sudden attack of inflammation
or chronic coming on gradually.
If glomerulonephritis occurs on its own, it's known as primary glomerulonephriti
s. If another disease, such as lupus or diabetes, is the cause, it's called seco
ndary glomerulonephritis. Treatment depends on the type of glomerulonephritis yo
u have.
Symptoms
By Mayo Clinic staff
Signs and symptoms of glomerulonephritis may depend on whether you have the acut
e or chronic form, and the cause. Your first indication that something is wrong
may come from symptoms or from the results of a routine urinalysis. Signs and sy
mptoms may include:
* Cola-colored or diluted, iced-tea-colored urine from red blood cells in yo
ur urine (hematuria)
* Foamy urine due to excess protein (proteinuria)
* High blood pressure (hypertension)
* Fluid retention (edema) with swelling evident in your face, hands, feet an
d abdomen
* Fatigue from anemia or kidney failure
* Less frequent urination than usual
When to see a doctor
Make an appointment with your doctor if you have a condition that's associated w
ith glomerulonephritis. Make an appointment promptly if you're experiencing any
of the signs or symptoms of glomerulonephritis.
Causes
By Mayo Clinic staff
CLICK TO ENLARGE
Illustration showing kidney cross section Kidney cross section
Each of your kidneys contains approximately 1 million tiny filters (glomeruli),
which attach to the opening of a small fluid-collecting tube (tubule). Each glom
erulus and tubule form a nephron, the functional unit of the kidneys. The glomer
uli 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 sav
ing 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 ur
inate.
Glomerulonephritis an inflammation of the glomeruli can damage your kidneys so t
hat they lose their filtering ability, allowing dangerous levels of fluid and wa
ste to accumulate in your body (called kidney failure) and depriving your bloods
tream of protein, which is excreted in your urine.
Often the cause of glomerulonephritis is unknown. Known causes include:
Infections
* Post-streptococcal glomerulonephritis. Glomerulonephritis may develop afte
r a strep infection in your throat or, rarely, on your skin (impetigo). Post-inf
ectious glomerulonephritis is becoming less common in the United States, most li
kely because of rapid and complete antibiotic treatment of most streptococcal in
fections.
* Bacterial endocarditis. Bacteria can occasionally spread through your bloo
dstream and lodge in your heart, causing an infection of one or more of your hea
rt valves. Those at greatest risk are people with a heart defect, such as a dama
ged or artificial heart valve.
* Viral infections. Among the viral infections that may trigger glomerulonep
hritis are the human immunodeficiency virus (HIV), which causes AIDS, and the he
patitis B and hepatitis C viruses, which primarily affect the liver.
Immune diseases
* 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 pneumon
ia, 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 sy
mptoms. The disorder seems to be more common in men than in women.
Vasculitis
* Polyarteritis. This form of vasculitis affects small and medium blood vess
els 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.
Conditions that cause scarring of the glomeruli
* High blood pressure. Damage to your kidneys and their ability to perform t
heir normal functions can occur as a result of high blood pressure. Glomerulonep
hritis can also cause high blood pressure because it reduces kidney function.
* Diabetic kidney disease. Diabetic kidney disease (diabetic nephropathy) ca
n affect anyone with diabetes. Diabetic nephropathy usually takes years to devel
op. Good control of blood sugar levels and blood pressure may prevent or slow ki
dney 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.
Chronic glomerulonephritis sometimes develops after a bout of acute glomerulonep
hritis. In some people there's no history of kidney disease, so the first indica
tion of chronic glomerulonephritis is chronic kidney failure. Infrequently, chro
nic glomerulonephritis runs in families. One inherited form, Alport syndrome, ma
y also involve hearing or vision impairment.
Complications
By Mayo Clinic staff
Complications of glomerulonephritis may include:
* Acute kidney failure. Loss of function in the filtering part of the nephro
n may cause waste products to accumulate rapidly. This condition may mean you'll
need emergency dialysis, an artificial means of removing extra fluids and waste
from your blood, typically by an artificial kidney machine (dialyzer).
* Chronic kidney failure. In this extremely serious complication, the kidney
s gradually lose function. Kidney function at less than 10 percent of normal cap
acity indicates end-stage kidney disease, which usually requires dialysis or a k
idney transplant to sustain life.
* High blood pressure. Damage to your kidneys and the resulting buildup of w
astes in the bloodstream can raise your blood pressure.
* Nephrotic syndrome. This is a group of signs and symptoms that may accompa
ny glomerulonephritis and other conditions that affect the filtering ability of
the glomeruli. Nephrotic syndrome is characterized by high protein levels in the
urine, resulting in low protein levels in the blood; high blood cholesterol; an
d swelling from fluid retention (edema) of the eyelids, feet and abdomen.
Preparing for your appointment
By Mayo Clinic staff
You're likely to start by first seeing your family doctor or a primary care prof
essional. However, in some cases when you call to set up an appointment, you may
be referred immediately to a kidney specialist (nephrologist).
To be sure you get the information you need, you can prepare for your appointmen
t.
What you can do
* Be aware of any pre-appointment restrictions. When you make the appointmen
t, ask if there's anything you need to do in advance, such as restrict your diet
.
* Write down the symptoms you're having, even if they seem unrelated to the
reason for your appointment.
* Write down key personal information, including any major stresses or recen
t life changes.
* Make a list of all medications, vitamins and supplements that you're takin
g.
* Take a companion along, if possible. Someone who accompanies you can help
you remember the information you get from your doctor.
* Write down questions you want answered.
List your questions from most important to least important in case time runs out
. For glomerulonephritis, some basic questions to ask your doctor include:
* How badly are my kidneys affected?
* What kinds of tests do I need?
* Is my condition likely temporary or chronic?
* Will I need dialysis?
* What restrictions do I need to follow?
* Should I see a specialist? What will that cost, and will my insurance cove
r seeing a specialist?
* Is there a generic alternative to the medicine you're prescribing me?
* Are there any brochures or other printed material that I can take home wit
h me? What Web sites do you recommend visiting?
In addition to the questions that you've prepared to ask your doctor, don't hesi
tate to ask questions during your appointment at any time that you don't underst
and something.
Tests and diagnosis
By Mayo Clinic staff
Specific signs and symptoms may suggest glomerulonephritis, but the condition of
ten comes to light when a routine urinalysis is abnormal. The urinalysis may sho
w:
* Red blood cells and red cell casts, an indicator of possible damage to the
glomeruli
* White blood cells, a common indicator of infection or inflammation
* Increased protein, which may indicate nephron damage
Other indicators, such as increased blood levels of creatinine or urea, also are
red flags. Or, your hard-to-control high blood pressure may cause your doctor t
o suspect glomerulonephritis.
If your doctor suspects glomerulonephritis, you may undergo one or more of the f
ollowing diagnostic procedures, in addition to urine testing:
* Blood tests. These can provide information about kidney damage and impairm
ent of the filtering mechanisms by measuring levels of waste products, such as c
reatinine and blood urea nitrogen.
* Imaging tests. If your doctor detects evidence of damage, he or she may re
commend diagnostic studies that allow visualization of your kidneys, such as a k
idney X-ray, an ultrasound examination or a computerized tomography (CT) scan.
* Kidney biopsy. This procedure involves using a special needle to extract s
mall pieces of kidney tissue for microscopic examination to help determine the c
ause of the inflammation. A kidney biopsy is almost always necessary to confirm
a diagnosis of glomerulonephritis.
Treatments and drugs
By Mayo Clinic staff
Treatment of glomerulonephritis and your outcome depend on:
* Whether you have an acute or chronic form of the disease
* The underlying cause
* The type and severity of your signs and symptoms
Some cases of acute glomerulonephritis, especially those that follow a strep inf
ection, often improve on their own and require no specific treatment.
To control your high blood pressure and slow the decline in kidney function, you
r doctor may prescribe one of several medications, including:
* Diuretics
* Angiotensin-converting enzyme (ACE) inhibitors
* Angiotensin II receptor agonists
Your doctor also may prescribe other drugs to treat the underlying cause of glom
erulonephritis:
* Strep or other bacterial infection. Your doctor likely will prescribe an a
ppropriate antibiotic.
* Lupus or vasculitis. Doctors often prescribe corticosteroids and immune-su
ppressing drugs.
* IgA nephropathy. Fish oil supplements have been successful in some people
with IgA nephropathy and are under study.
* Goodpasture's syndrome. Plasmapheresis is sometimes used to treat people w
ith Goodpasture's syndrome. Plasmapheresis is a mechanical process that removes
antibodies from your blood by taking the plasma out of your blood and replacing
it with fluid or donated plasma.
Therapies for associated kidney failure
For acute glomerulonephritis and acute kidney failure, temporary dialysis can he
lp remove excess fluid and control high blood pressure. The only long-term thera
pies for end-stage kidney failure are kidney dialysis and kidney transplantation
. When a transplant isn't possible, often because of poor general health, dialys
is becomes the only option.
Lifestyle and home remedies
By Mayo Clinic staff
Your doctor may recommend changes in your diet, including:
* Restricting salt intake to prevent or minimize fluid retention, swelling a
nd hypertension
* Cutting back on protein and potassium consumption to slow the buildup of w
astes in your blood
If you have diabetes, the following may help slow kidney damage:
* Maintain a healthy weight
* Control your blood sugar level
Coping and support
By Mayo Clinic staff
Because living with chronic glomerulonephritis and chronic kidney failure can ta
x your emotional resources, you might benefit from joining a support group. Such
a group can provide both sympathetic listening and useful information. To find
out about support groups in your area that deal with kidney disease, ask your do
ctor or contact the National Kidney Foundation to find the chapter nearest you.
Prevention
By Mayo Clinic staff
There's no way to prevent most forms of glomerulonephritis. However, here are so
me steps that may be beneficial:
* Seek prompt treatment of a strep infection causing a sore throat or impeti
go.
* To prevent infections, such as HIV and hepatitis, that can lead to some fo
rms of glomerulonephritis, follow safe-sex guidelines and avoid intravenous drug
use.
* Control your blood sugar to help prevent diabetic nephropathy.
* Control your blood pressure, which lessens the likelihood of damage to you
r kidneys from hypertension.