Chronic Glomerulonephritis

What is glomerulonephritis?
Glomerulonephritis (GN) is inflammation of the glomeruli(pic),
o which are structures in your kidneys that are made up of tiny blood vessels.
o These knots of vessels help filter your blood(bullet) and remove excess fluids.
o If your glomeruli are damaged, your kidneys cannot get rid of waste & will stop working
properly, and you can go into kidney failure.

(aka nephritis or nephrotic syndrome; requires immediate treatment. )

Types
GN can be both acute, or sudden, and chronic, or long-term. (topics)
o Acute You may get it after an infection in your throat or on your skin.
o May recover without treatment, but should look out for early symptoms and seek
treatment.
Chronic Glomerulonephritis!!! (ribbons and animations and because post-intro)
o The chronic form may develop silently (without symptoms) over several years.
o often leads to complete kidney failure.
Pathology & Etiology
Early signs and symptoms
o Blood or protein in the urine (hematuria, proteinuria)
o High blood pressure
o Swelling of your ankles or face (edema)
o Frequent nighttime urination
o Very bubbly or foamy urine
Symptoms of kidney failure include:
o Lack of appetite
o Nausea and vomiting
o Tiredness
o Difficulty sleeping
o Dry and itchy skin
o Nighttime muscle cramps

The acute disease may be caused by infections such as strep throat

o Sometimes, you will have one acute attack of the disease and develop the chronic form
years later.
Chronic can run in the family (hereditary)
o often shows up in young men who may also have hearing loss and vision
loss(complications)
 o Some forms are caused by changes in the immune system.
o However, in many cases, the cause is not known.
The causes of GN depend on whether its acute or chronic.

Acute GN
Acute GN can be an overreacting response to an infection such as strep throat or an abscessed tooth.
This can go away without treatment.

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 ultimately lead to complete kidney failure.

Chronic GN doesnt always have a clear cause. A genetic disease can sometimes cause chronic GN.
Hereditary nephritis occurs in young men with poor vision and poor hearing. Other possible causes
include:

certain immune diseases

a history of cancer
exposure to some hydrocarbon solvents

As well, having the acute form of GN may make you more likely to develop chronic GN later on.

Kidney failure
Your GN may be so advanced that you develop kidney failure. Some of the symptoms of this include:

fatigue
lack of appetite
nausea and vomiting
insomnia
dry, itchy skin
muscle cramps at night

What Is Chronic Glomerulonephritis?

Chronic glomerulonephritis is a kidney disorder caused by slow, cumulative damage and scarring of the
tiny blood filters in the kidneys. These filters, known as glomeruli, remove waste products from the
blood.

In chronic glomerulonephritis, scarring of the glomeruli impedes the filtering process, trapping waste
products in the blood while allowing red blood cells or proteins to escape into the urine, eventually
producing the characteristic signs of high blood pressure and swelling in the legs and ankles.

The disorder may first come to ones attention because of high blood pressure. In others, fluid retention
and/or foamy urine may be the first signs. Long-term inflammation and scarring (sclerosis) of the
kidneys may lead to kidney failure in severe cases. Damage may progress without symptoms for months
or years; by the time symptoms appear, the course of the disorder may be irreversible.

What Causes Chronic Glomerulonephritis?

The specific cause of most cases of chronic glomerulonephritis is unknown.
Viral infections, such as hepatitis B or C and acquired immunodeficiency syndrome (AIDS), may lead
to chronic glomerulonephritis.
Autoimmune disorders, such as systemic lupus erythematosus, or other causes of vasculitis
(inflammation of small blood vessels) may cause chronic glomerulonephritis.
Acute glomerulonephritis may, after a symptom-less period of many years, reappear as chronic
glomerulonephritis.

Symptoms of Chronic Glomerulonephritis

Blood or protein in the urine may be found on routine urinalysis
Facial [uffiness in the morning
Swelling of the legs or ankles or other parts of the body, due to fluid accumulation (edema)
Shortness of breath during exertion due to anemia
Headache or other symptoms of high blood pressure
In severe cases, symptoms of kidney failure, including fatigue; seizures; nausea and vomiting; loss of
appetite; overall itching; headache; easy bruising; frequent hiccups or bleeding; and impaired vision
Increased pigmentation of the skin
Abdominal pain

Diagnosis of Chronic Glomerulonephritis

How is a diagnosis of glomerulonephritis made?
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.

Patient history and physical examination

Blood and urine tests
Chest x-ray to show fluid overload.
An ultrasound study of the kidneys may be performed to evaluate the size of the kidneys.
A kidney biopsy may be performed. Under local anesthesia, the doctor inserts a needle into the
kidney through the back to extract a small sample of tissue.
Computed tomography (CT) scan or abdominal ultrasound can be performed to show damage to
the glomeruli.
How is GN diagnosed?
 The first step in diagnosis is a urinalysis test. Blood and protein in urine are important markers for
the disease. A routine physical exam for another condition can also lead to the discovery of GN.
More urine testing may be necessary to check for important signs of kidney health, including:
creatinine clearance
total protein in the urine
urine concentration
urine specific gravity
urine red blood cells
urine osmolality
Blood tests may show:
anemia, which is a low level of red blood cells
abnormal albumin levels
abnormal blood urea nitrogen
high creatinine levels
Your doctor may also order immunology testing to check for:
antiglomerular basement membrane antibodies
antineutrophil cytoplasmic antibodies
antinuclear antibodies
complement levels
Results of this testing may show your immune system is damaging your kidneys.
A biopsy of your kidneys may be necessary to confirm the diagnosis. This involves analyzing a small
sample of kidney tissue taken by a needle.
To learn more about your condition, you may also have imaging tests such as the following:
CT scan
kidney ultrasound
chest X-ray
intravenous pyelogram

How to Treat Chronic Glomerulonephritis

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.

What treatment is available for 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

Antihypertensive drugs may be prescribed to reduce high blood pressure.

Diuretics may be prescribed to reduce excess fluid retention and increase urine production.
Your doctor may advise you to eat a low-protein, low-salt diet and to take iron or vitamin
supplements. (Do not take iron supplements without your doctors approval.)
Steroid medication or immunosuppressive drugs may be prescribed for some patients.
In severe cases where kidney failure occurs, dialysis may be necessary. Dialysis performs the
functions of the kidney by removing waste products and excess fluid from the blood when the
kidney cannot (Renal Failure, Chronic).
A kidney transplant is an alternative to dialysis in cases of kidney failure.
What treatments are available for GN?
Treatment options depend on the type of GN youre experiencing and its cause.
One treatment is to control high blood pressure, especially if thats the underlying cause of the GN.
Blood pressure may be very hard to control when your kidneys arent working properly. If this is the
case, your doctor may prescribe blood pressure medications, including angiotensin-converting
enzyme inhibitors, or ACE inhibitors, such as:
captopril
lisinopril (Zestril)
perindopril (Aceon)
Your doctor may also prescribe angiotensin receptor blockers, or ARBs, such as:
losartan (Cozaar)
irbesartan (Avapro)
valsartan (Diovan)
Corticosteroids may also be used if your immune system is attacking your kidneys. They reduce the
immune response.
Another method to reduce immune-triggered inflammation is plasmapheresis. This process removes
the fluid part of your blood, called plasma, and replaces it with intravenous fluids or donated plasma
that contains no antibodies.
For chronic GN, youll 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. Check with your general
practitioner or kidney specialist for guidelines about diet restrictions or supplements. They can set
you up with a medical dietician to advise you on your choices.
 If your condition becomes advanced and you develop kidney failure, you may need to have dialysis.
In this procedure, a machine filters your blood. Eventually, you may need a kidney transplant.

What are the complications associated with GN?

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:
A low salt diet
Diuretics (water pills)
Blood pressure medications.

GN can lead to nephrotic syndrome, which causes you to lose large amounts of protein in your urine.
This leads to a lot of fluid and salt retention in your body. You can develop high blood pressure, high
cholesterol, and swelling throughout your body. Corticosteroids treat this condition. Eventually,
nephrotic syndrome will lead to end-stage renal disease if it doesnt come under control.
The following conditions can also occur due to GN:
acute kidney failure
chronic kidney disease
electrolyte imbalances, such as high levels of sodium or potassium
chronic urinary tract infections
congestive heart failure due to retained fluid or fluid overload
pulmonary edema due to retained fluid or fluid overload
high blood pressure
malignant hypertension, which is rapidly increasing high blood pressure
increased risk of infections

What is the long-term outlook?

If caught early, acute GN can be temporary and reversible. Chronic GN may be slowed with early
treatment. If your GN worsens, it will likely lead to reduced kidney function, chronic kidney failure, and
end-stage renal disease.
Severe kidney damage, kidney failure, and end-stage renal disease may eventually require dialysis and a
kidney transplant.
The following are positive steps to recover from GN and prevent future episodes:
Maintain a healthy weight.
Restrict salt in your diet.
Restrict protein in your diet.
Restrict potassium in your diet.
Quit smoking.
In addition, meeting with a support group can be a helpful way for you to deal with the emotional stress
of having a kidney disease.

Wiki Stuff
The nephrotic syndrome is characterised by the finding of edema in a person with increased
protein in the urine and decreased protein in the blood, with increased fat in the blood.
Inflammation that affects the cells surrounding the glomerulus, podocytes, increases the
permeability to proteins, resulting in an increase in excreted proteins. When the amount of
proteins excreted in the urine exceeds the liver's ability to compensate, fewer proteins are
detected in the blood - in particular albumin, which makes up the majority of circulating
proteins. With decreased proteins in the blood, there is a decrease in the oncotic pressure of
the blood. This results in edema, as the oncotic pressure in tissue remains the same. It should be
noted here that although decreased intravascular oncotic (i.e. osmotic) pressure partially
explains the patient's edema, more recent studies have shown that extensive sodium retention
in the distal nephron (collecting duct) is the predominant cause of water retention and edema in
the nephrotic syndrome.[3] This is worsened by the secretion of the hormone aldosterone by
the adrenal gland, which is secreted in response to the decrease in circulating blood and causes
sodium and water retention. Hyperlipidemia is thought to be a result of the increased activity of
the liver.[4]:549
Still need:

Tests
Collection requirements (additives, handling, patient prep)
Microscopy results (images)

Chronic diseases generally?