Glomerulonephritis

What is glomerulonephritis?

Glomerulonephritis is an inflammation of the body of both kidneys. The inflammation can be caused by many different conditions. but is usually due to an overactivity of the immune system.

Symptoms

There are seven different types of glomerulonephritis, that present in very different ways. For some types, symptoms can include ankle swelling that develops over months or years. For others, shortness-of-breath over days or weeks (due to water in the lungs) causing a rapid onset of kidney failure.

The outlook is also variable, from complete recovery with no treatment, to end-stage renal failure (ESRF), requiring dialysis and/or a transplant. Some types of glomerulonephritis can return in a transplant.

The various symptoms of the different types also include:

• Swelling of the face, eyes and legs
• Reduction in urine volume
• Dark urine (containing blood which may not be visible)
• Headaches and visual disturbances
• Drowsiness
• Tiredness and general malaise (feeling ill)
• Nausea
• Loss of appetite
• Rashes and itchy skin

Tests for the condition show protein, blood cells, and kidney cells in the urine, while a high concentration of the body's waste products (such as urea and creatinine) may be found in the blood.

Swabs of the throat may show there's been a streptococcal infection, while blood tests may be used to check for antibodies to streptococci or other infections, or signs of an abnormal immune response.

All patients will need a kidney biopsy (removal of a piece of kidney with a needle) to make a definite diagnosis.

Sometimes when there are no symptoms, the problem is picked up by a routine blood test, or during investigation of high blood pressure

Causes and risk factors

The types of glomerulonephritis tend to be different in adults and children.

In children, the commonest type is minimal change nephropathy, which usually goes away with steroid treatment.

Children may also get two more acute types called Henoch-Schönlein Purpura (an inflammation of the blood vessels caused by an abnormal immune response) and haemolytic-uraemic syndrome (an abnormal immune reaction with triggers including gastrointestinal infection). Both may result in either complete recovery, or long term dialysis and transplantation.

In adults, other types occur, including:

• IgA nephropathy (the commonest type)
• Membranous
• Mesangio-capillary
• Focal and segmental (FSGS) glomerulonephritis

In most cases, no cause is found. Though in a few patients, they may be ‘set off’ by an infection or a cancer. Post-streptococcal glomerulonephritis is now extremely rare

There is also a very serious type called ’rapidly progressive glomerulonephritis’ (RPGN), which can follow a flu-like illness in the month before symptoms start in 50 per cent of patients. This can cause kidney failure in days or weeks and can be linked to bleeding from the lungs, causing blood to be coughed up.

Treatment and recovery

The treatment depends on the type and cause of the condition. The aim is to reduce inflammation, limit the damage to the kidneys and support the body until kidney function is back to normal.

Restriction of sodium (salt), potassium, protein and fluids in the diet may be necessary. Steroids, or more powerful immunosuppressant drugs ( some used in cancer), may be given to reduce the inflammation. A technique called ‘plasma exchange’ (which is similar to dialysis) can also be used (especially in RPGN) to suppress the immune system.

Antibiotics may be needed too, although in many cases the infection that initially triggered the condition has long since gone. Medication may also be needed to control blood pressure.

In severe cases, renal dialysis may be necessary. This may be a temporary or permanent measure. A transplant may then be necessary.