Definition

By Mayo Clinic staff

Kidney cross section

Glomerulonephritis (gloe-mer-u-lo-nuh-FRY-tis) is inflammation of the tiny filters in your kidneys (glomeruli). Glomeruli remove excess fluid, electrolytes and waste from your bloodstream and pass them into your urine. Also called glomerular 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 glomerulonephritis. If another disease, such as lupus or diabetes, is the cause, it's called secondary glomerulonephritis. If severe or prolonged, the inflammation associated with glomerulonephritis can damage your kidneys. Treatment depends on the type of glomerulonephritis you have. Signs and symptoms of glomerulonephritis may depend on whether you have the acute 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 symptoms may include: Pink or cola-colored urine from red blood cells in your urine (hematuria) Foamy urine due to excess protein (proteinuria) High blood pressure (hypertension) Fluid retention (edema) with swelling evident in your face, hands, feet and abdomen Fatigue from anemia or kidney failure

Causes
By Mayo Clinic staff

Kidney cross section

A variety of conditions can cause glomerulonephritis, ranging from infections that affect your kidneys to diseases that affect your whole body, including your kidneys. Sometimes the cause is unknown. Here are some examples of conditions that can lead to inflammation of the kidneys' glomeruli:

Infections Post-streptococcal glomerulonephritis. Glomerulonephritis may develop a week or two after recovery from a strep throat infection or, rarely, a skin infection (impetigo). An overproduction of antibodies stimulated by the infection may eventually settle in the glomeruli, causing inflammation. Symptoms usually include swelling, reduced urine output and blood in the urine. Children are more likely to develop post-streptococcal glomerulonephritis than are adults, and they're also more likely to recover quickly. 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. Bacterial endocarditis is associated with glomerular disease, but the exact connection between the two is unclear. 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. 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 immunological 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. Vasculitis 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. Conditions that are likely to cause scarring of the glomeruli High blood pressure. Damage to your kidneys and their ability to perform their normal functions can occur as a result of high blood pressure. Glomerulonephritis 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. Chronic glomerulonephritis sometimes develops after a bout of acute glomerulonephritis. In some people there's no history of kidney disease, so the first indication of chronic glomerulonephritis is chronic kidney failure. Infrequently, chronic glomerulonephritis runs in families. One inherited form, Alport syndrome, may also involve hearing or vision impairment.

Glomerulonephritis The glomeruli are structures in your kidneys made up of tiny blood vessels. These knots ofvessels help filter blood and remove excess fluid. If your glomeruli are damaged, yourkidneys will stop longer work properly, and your body can go into kidney failure. Conditions that damage the glomeruli are collectively referred to as glomerulonephritis (GN). Glomerulonephritis is a serious illness that can be life threatening and requires immediate treatment. Sometimes this condition is called nephritis or nephrotic syndrome. There can be both acute (sudden) glomerulonephritis and chronic (long-term) glomerulonephritis. What Are the Causes of Glomerulonephritis? There are two categories of glomerulonephritis: acute and chronic.
Causes of Acute GN

Acute GN can start in response to an infection such as strep throat or an abscessed tooth. It may be caused by problems with your immune system overreacting to the infection. This may go away on its own without treatment. If it doesnt go away, immediate treatment is necessary to prevent long-term damage to your kidneys. Illnesses that have been known to trigger GN include: strep throat systemic lupus erythematosus (also called SLE or lupus) Goodpastures syndrome (a rare autoimmune disease where antibodies attack the kidneys and lungs) amyloidosis (proteins that are deposited in organs and tissue, and can cause harm) Wegeners granulomatosis (a rare disease that causes inflammation of the blood vessels) polyarteritis nodosa (a disease where cells attack arteries) Heavy use of NSAID pain relievers (ibuprofen, naproxen) may also be a risk factor.

Causes of Chronic GN

The chronic form of GN can develop over several years with no or very few symptoms. This can cause irreversible damage to your kidneys and lead to complete kidney failure. Chronic GN may sometimes be caused by a genetic disease. Hereditary nephritis occurs in young men with poor vision and poor hearing. Immune diseases may also cause chronic GN. A history of cancer may also put you at risk. Having the acute form may make you more likely to develop the chronic form later on. Exposure to some hydrocarbon solvents may increase the risk of chronic GN. Sometimes there is no clear reason why you develop chronic GN. Twenty-five percent of people with the condition have no prior history of kidney disease. What Are the Symptoms of Glomerulonephritis?
Symptoms of Acute GN

Early symptoms of acute glomerulonephritis include: puffiness in the face (edema) urinating less often blood in your urine (dark, rust-colored urine) extra fluid in your lungs causing coughing high blood pressure
Symptoms of Chronic GN

Often, the chronic form of glomerulonephritis can creep up without any symptoms. Sometimes there may be slow development of symptoms similar to the acute form. Some symptoms which may occur include: blood or protein in urine (may be microscopic and show up in urine tests) high blood pressure swelling in ankles and face (edema) frequent nighttime urination bubbly or foamy urine (from excess protein) abdominal pain nosebleeds
Symptoms of Kidney Failure

Your GN may be so advanced that you are developing kidney failure. You may have some of the following symptoms: fatigue lack of appetite nausea and vomiting insomnia dry, itchy skin muscle cramps at night

How Is Glomerulonephritis Diagnosed? The first step in diagnosis is to have a urinalysis test. However, GN is often discovered when you have a routine physical to treat another condition. Blood and protein in the urine during urinalysis are important markers for the disease. More urine testing may be done to check important signs of kidney health, including: creatinine clearance total protein in urine urine concentration urine specific gravity urine red blood cells (RBCs) urine osmolality Blood tests may show anemia (low level of red blood cells), abnormal albumin levels, abnormal blood urea nitrogen, and high creatinine levels. Immunology testing may also be done to check for things such as: antiglomerular basement membrane antibodies antineutrophil cytoplasmic antibodies antinuclear antibodies complement levels These are all signs that your immune system may be damaging your kidneys. A biopsy (a small sample taken with a needle) of the kidneys may be necessary to confirm the diagnosis. To learn more about your condition, you may also have scans such as: computed tomography (CT) scan kidney ultrasound chest X-ray intravenous pyelogram (X-ray of kidneys with dye) What Treatments Are Available for Glomerulonephritis? Different types of glomerulonephritis have varying causes and may require different treatments. One of the first focuses of therapy is to control high blood pressure. Blood pressure may be very hard to control when your kidneys are malfunctioning. If this is the case, your doctor may prescribe blood pressure medications, including angiotensin-converting enzyme inhibitors (i.e. captopril, lisinopril, perindopril, etc.) or angiotensin receptor blockers (i.e. losartan, irbesartan, valsartan, etc.). Other medications such as corticosteroids may be prescribed reduce your immune response if your immune system is attacking your kidneys. Another method used to reduce the immune-triggered inflammation is plasmapheresis. The fluid part of the blood (plasma) is removed and replaced with intravenous (IV) fluids or donated plasma (with no antibodies). For the chronic form of the disease, you will need to reduce the amount of protein, salt, and potassium in your diet. Additionally, you must watch how much liquid you drink. Calcium supplements may be recommended, and you may need to take diuretics to reduce swelling.

If your condition becomes advanced and you develop kidney failure, you may need to havedialysis where your blood is filtered by a machine. Eventually you may need a kidney transplant. Long-Term Outlook and Potential Complications Acute GN, if caught early, can be temporary and reversible. Chronic GN may be slowed with early treatment. But if your GN worsens, it will likely lead to reduced kidney function,chronic kidney failure, and end-stage renal disease. Glomerulonephritis can lead to nephrotic syndrome, where you lose large amounts of protein in your urine. This leads to a lot of fluid and salt retained in your body. You develop high blood pressure, high cholesterol, and swelling throughout your body. This is treated with corticosteroids. If the syndrome cannot be controlled, then eventually end-stage renal disease will result. Severe kidney damage, kidney failure, and end-stage renal disease may eventually requiredialysis and the need for a kidney transplant. The following conditions can also occur due to GN: acute kidney failure chronic kidney disease end-stage renal disease acute nephrotic syndrome electrolyte imbalances (high levels of sodium, potassium, etc.) chronic urinary tract infections congestive heart failure due to retained fluid or fluid overload pulmonary edema due to retained fluid or fluid overload hypertension, malignant hypertension (rapidly increasing high blood pressure) increased risk of other infections

Glomerulonephritis is also known asglomerular nephritis (GN) or glomerular disease. It is a disease of the kidney, characterized by inflammation of the glomeruli. Glomeruli are very small blood vessels in the kidneys that act as tiny little filters - there are about one million glomeruli in each kidney. The disease damages the kidneys' ability to remove waste and excess fluids from the body. GN can be acute, meaning there is a sudden attack of inflammation, or chronic (long-term and coming on gradually). People can develop glomerulonephritis on its own, in which case it is called primary glomerulonephritis. If it is caused by another disease, such as diabetes or lupus, infection, or drugs it is called secondary glomerulonephritis.

What are the signs and symptoms of glomerulonephritis?

A symptom is something the patient feels or reports, while a sign is something other people, including the doctor may detect. For example, a headache may be a symptom while a rash may be a

sign. Some patients may not show any clear symptoms. The type of signs and symptoms will usually depend on whether it is the acute or chronic form, and its cause. For some people, their first indication that something is not right is when the results of a urine or blood sample test come back.

Urine - if the glomeruli are damaged there will be a small amount of blood and/or protein in the urine, which may be visible or will show up in a urine test. If symptoms are more severe the individual's urine will turn visibly red - sometimes it may be Coca-cola colored. If the urine is cloudy or frothy it means that excess protein is present (proterinuria). A healthy adult urinates between 1 to 1.5 liters per day. People with severe glomerulonephritis may spend two or three days without being able to urinate; and when they do, there may be blood and/or protein in the urine.

Kidney damage - in the initial stage the inflammation of the kidneys may not be evident. Symptoms may suddenly appear, or come on about three weeks after infection. Patients with glomerulonephritis caused by kidney damage may have the following signs or symptoms:
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An elevated body temperature (typically about 38C, 100.4F) Breathing difficulties Edema (swelling), especially in the hands, face, feet, ankles or abdomen Loss of appetite Nausea Pallor Vision problems Vomiting