Glomerulonephritis:
Definition, Symptoms, and Treatment
Glomerulonephritis, also
called nephritis or nephrotic syndrome, is the medical term for kidney disease,
specifically the glomeruli. It can be caused by several disorders such as infections,
hereditary genetic disorders, or autoimmune diseases. The condition manifests
with various symptoms such as edema, high blood pressure, and hematuria. The
diagnosis is based on blood and urine tests, sometimes supplemented with
medical imaging or a biopsy. The treatment of glomerulonephritis is based on
dietary measures and diuretic drugs or antibiotics treated by nephrology physicians
A glomerulonephritis is a damage to the
glomerulus (kidney filtration units). It can be acute (rapid development) or
chronic (slow development). We speak of primary glomerulonephritis when the
origin of the disorder is kidney damage and secondary glomerulonephritis in the
event of an existing underlying pathology.
About Kidneys
The kidneys belong to
the urinary system, which also includes the bladder, ureters (ducts connecting
the kidneys to the bladder), and the urethra. The kidneys are essential because
they function as a filter to rid the blood of wastes and eliminate them through
the production of urine. The kidneys remove wastes from the body such as urea,
uric acid, or creatinine and foreign substances (e.g., drug residues), which,
when accumulated, are toxic to the body.
Each kidney is made up
of almost 1 million urine-producing units called nephrons. Each nephron is made
up of:
- A blood filtration system is called the
glomerulus. The glomerulus is made up of a multitude of small blood
vessels, the capillaries, organized in microscopic balls.
- A network of tubules allows the filtrate
to be collected to constitute the urine excreted via the urethra.
Types of
Glomerulonephritis
Following are the two
main types which are as follow: -
Acute
glomerulonephritis
Acute glomerulonephritis
mainly occurs following a skin or throat infection with bacteria
(streptococci). This type typically develops in children aged 2 to 10 years
after the underlying infection has healed. Certain viral infections, such as
chickenpox, or parasitic infections, such as malaria, can also be the cause of
acute glomerulonephritis, then called “post-infectious glomerulonephritis.”
Acute glomerulonephritis is sometimes caused by non-infectious disorders such
as systemic lupus erythematosus. When the disease progresses rapidly, it is
usually caused by conditions involving the immune system.
Chronic
glomerulonephritis
Chronic
glomerulonephritis is often caused by the same conditions that cause acute
glomerulonephritis. It also happens that the acute form, instead of being
cured, evolves into a chronic form. However, in many cases, chronic
glomerulonephritis has no identified cause.
Symptoms
Almost half of the
people with acute glomerulonephritis have no symptoms. They are said to be
asymptomatic. When symptoms do occur, there is swelling of the tissues, reduced
urine volume, and dark urine output. The edema first appears on the face and
eyelids and then on the legs. The more kidney function is impaired, the more
blood pressure increases. Some patients are drowsy or confused. In the elderly,
the symptoms are not specific: nausea and deterioration of the general
condition.
The rapidly developing
glomerulonephritis occurs mainly by fatigue, fever, and weakness.
Other symptoms can be associated: loss of appetite, nausea, vomiting, joint and
muscle pain. Almost 50% of patients have a flu-like syndrome the month before
kidney failure. A chronic glomerulonephritis is causing
symptoms lighter, resulting in delayed diagnosis. An increase in blood pressure
is expected, sometimes associated with edema. When the disease progresses to
kidney failure, itching, fatigue, nausea, vomiting, loss of appetite, and
respiratory distress appear.
The prognosis for
glomerulonephritis depends on the speed of treatment and the type. The longer
the treatment, the more likely patients are to develop chronic kidney disease
with kidney failure. Between 80% and 90% of patients with rapidly progressive
glomerulonephritis require dialysis.
Diagnosis
The glomerulonephritis
is evoked by the physician in patients with symptoms suggestive of the disease,
or the results of a biological analysis routine seem to indicate renal
dysfunction or blood in the urine.
With rapidly
progressing glomerulonephritis, aggregates of red blood cells are often
visible in a urine sample examined under a microscope. Blood tests usually show
associated anemia. A kidney biopsy is generally done to confirm the diagnosis
and determine the origin of the disease. A kidney biopsy involves inserting a
needle, under ultrasound, into one of the kidneys to obtain a sample of the
kidney tissue. A chronic glomerulonephritis evolves gradually,
making the dating of symptoms difficult and imprecise. The disease can be
detected during a routine urinalysis performed for another reason. Even if the
patients feel well, this may reveal the presence of blood and protein in the
urine, indicating kidney dysfunction. An imaging test such as an ultrasound or
a CT scan is then necessary. To distinguish chronic glomerulonephritis from
other disorders, a biopsy is the most reliable diagnostic method. Other medical
examinations may be ordered to identify the cause of the pathology. For
example, for post-infectious glomerulonephritis, the culture of a throat swab
may be helpful to identify the streptococcus involved. When doctors suspect
glomerulonephritis of autoimmune origin, they order a blood test to look for
autoantibodies (antibodies against the body).
Treatment
Acute
glomerulonephritis
The Glomerulonephritis
Acute has no specific treatment. Management involves a diet low in protein and
sodium until kidney function improves. Diuretic therapy promotes renal
excretion of water and sodium. Treatment of arterial hypertension is
associated. When a bacterial infection is suspected to be the cause of acute glomerulonephritis,
antibiotics are ineffective since the disease usually starts after the
infection has healed. The antibiotic is only recommended if the infection is
still present. Antimalarial treatments after the opinions of nephrology physicians can be effective when
glomerulonephritis is caused by malaria.
- Rapidly progressive glomerulonephritis
The rapidly progressive
glomerulonephritis is treated with immunosuppressants. Treatment should be as
early as possible. Intravenous and then oral corticosteroids are combined.
2.
Chronic glomerulonephritis
The chronic
glomerulonephritis was treated with antihypertensives. The aim is to slow the
progression of the disease by reducing blood pressure and the excretion of protein
in the urine. A diet restrictive in protein slightly reduces renal degradation.
At an advanced stage, dialysis or kidney transplantation is inevitable.
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