Glomerulonephritis is a disease that involves inflammation of the glomeruli — the filtering units of the kidneys. This inflammation and subsequent damage to the glomeruli affects their ability to filter waste products and excess water from the blood. Glomerulonephritis may be either acute, with a sudden onset of inflammation, or chronic, involving persistent inflammation that comes on more gradually.
Types of glomerulonephritis
There are many types of glomerulonephritis, the most common occurs when the body’s immune system attacks the glomeruli. These autoimmune types of acute glomerulonephritis include IgA nephropathy.
Young adults are the most likely people to be affected by IgA nephropathy. The first sign of disease is often an episode of passing blood-stained urine in association with an infection such as flu or a sore throat. The red urine episode usually occurs within a day or so of the respiratory infection and comes to an end by itself. This is in contrast to another type of glomerulonephritis, post-streptococcal glomerulonephritis, where the blood-stained or dark urine episode does not occur until about 10 days after the sore throat. This delay coincides with the formation of antigen/antibody (immune) complexes that are deposited in the glomeruli and cause acute damage.
Children over the age of 5 years are the most likely group to be affected by post-streptococcal glomerulonephritis, particularly those living in indigenous communities.
Chronic glomerulonephritis can develop over many years and is usually of uncertain cause. Known causes include malaria, hepatitis or systemic lupus erythematosus (SLE, or lupus).
Symptoms of glomerulonephritis
Sometimes there are no symptoms of glomerulonephritis and the disease is picked up only incidentally by the detection of microscopic blood or protein on a urine test taken in your doctor’s surgery. Sometimes the blood in the urine can be seen with the naked eye.
Along with blood in the urine, glomerulonephritis can be associated with swelling and puffiness, particularly of the face, and maybe of the legs and scrotum. This is caused by the loss of protein through the kidneys into the urine. Other symptoms may include fatigue, irritability and pain over the kidneys.
High blood pressure may develop as a serious complication of glomerulonephritis.
Occasionally, glomerulonephritis may remain silent for a long period until kidney failure occurs. Symptoms of kidney failure include lack of appetite, nausea and vomiting, fatigue, difficulty sleeping, dry and itchy skin, and passing a smaller amount of urine than normal. Glomerulonephritis can be sudden and severe — progressing to kidney failure very rapidly — but this is rare.
Diagnosis of glomerulonephritis
In addition to urine and blood tests, your doctor will need to perform a renal (kidney) biopsy to make the diagnosis (and determine the type) of glomerulonephritis.
Treatment of glomerulonephritis
Treatment depends largely on the type of glomerulonephritis you have, and the severity of the disease. Usually, the acute form eventually goes away by itself. However, hospital admission is often warranted in the short term.
In acute cases, oral corticosteroids are sometimes needed. In children with post-streptococcal glomerulonephritis (following streptococcus infection), antibiotics are given to eradicate the infection, and the nephritis usually resolves completely.
In most cases, there is no specific cure available. A low-protein, low-salt diet may be advised to take the load off the kidneys. Similarly, restricting your fluid intake and taking diuretics may be required if swelling is a continuing problem.
In people with high blood pressure, medicine to control the blood pressure is often necessary.
The great majority of children with acute glomerulonephritis will recover in a period of weeks to months without complications. Adults tend to recover more slowly.
The outlook for chronic (ongoing) glomerulonephritis is more variable depending upon the type. Glomerulonephritis and diabetic kidney disease are the 2 most common causes of chronic kidney failure in Australia.
2. Kidney Health Australia [website]. IgA Nephropathy (updated 2007, Mar). Available at: http://www.kidney.org.au/LinkClick.aspx?fileticket=yCN1frLMAIg%3d&tabid=609&mid=881 (accessed 2010, Apr 19)
3. Mayo Clinic [website]. Glomerulonephritis (updated 2009, Apr 4). Available at: http://www.mayoclinic.com/health/glomerulonephritis/DS00503 (accessed 2010, Apr 19)