Glomerulonephritis (Nephritic / Nephrotic Syndrome)

What is Nephritic – Nephrotic syndrome?

Do You Have Any of these?

• Foamy urine
• Blood in the urine
• Swelling of the feet, hands, around the eyes
• High blood pressure
• Rise in blood creatinine levels

Our kidneys have 1 - 1.2 million nephrons which are the functional unit of kidney. They are specialized cells containing glomeruli, tubules, interstitium and vascular compartment which functions to purify the blood of waste products and also have hormonal functions helping to maintain homeostasis(1^✔ ✔Trusted Source
Basics of renal anatomy and physiology

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Glomerulonephritis is the term used to describe group of diseases that damage the glomerulus(2^✔ ✔Trusted Source
Glomerulonephritis

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The spectrum of glomerular diseases leads to inflammation of glomerulus and leakage of red blood cells and various molecular weight proteins. Albumin is the major protein which leaks leads to loss of the oncotic pressure (water absorbing capacity) in the blood vessels leading to leakage of water out of the circulatory system amounting to fluid accumulation in the face, legs ankles and swelling of whole body(3^✔ ✔Trusted Source
Histology, Kidney and Glomerulus

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Classification of Glomerulonephritis

• Acute Glomerulonephritis – sudden occurrence of nephritic syndrome after an infection, inflammation, drug related(2^✔ ✔Trusted Source
  Glomerulonephritis
  
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• Chronic Glomerulonephritis – slowly progressive nephritic-nephrotic syndrome leading to permanent kidney damage and need for kidney replacement therapy(2^✔ ✔Trusted Source
  Glomerulonephritis
  
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Symptoms and Signs of Glomerulonephritis

Generalised swelling of whole body

Protein leak in the urine

Low blood albumin

High blood pressure

Blood in urine

Loss of filtration function

Joint pains/blood in sputum / skin rashes (may point to specific etiology)

What are the Causes of Glomerulonephritis?

Broadly we can divide the causes as follows:

A. Autoimmune diseases: The native immune system creates antibodies against the own antigens leading to damage to many organs. It can affect the skin, brain, blood system, kidneys, heart, lung etc. It may also affect specific organs.

In an autoimmune disease, the immune system creates autoantibodies, which are antibodies or immunoglobulins that attack the body itself. Autoimmune diseases may be systemic and affect many parts of the body, or they may affect only specific organs or regions(6^✔ ✔Trusted Source
Nature and functions of autoantibodies

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B. Familial/hereditary: These diseases run in families with early presentation like Alport syndrome, congenital nephrotic syndrome, thin basement membrane disease. Symptom presentation like early age of onset and genetic study will confirm diagnosis(7^✔ ✔Trusted Source
Familial risks of glomerulonephritis - a nationwide family study in Sweden

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C. Infective: Glomerular disease sometimes develops rapidly after an infection in other parts of the body. Acute post-streptococcal glomerulonephritis (PSGN), HIV and some other infections(8^✔ ✔Trusted Source
Glomerular Diseases Associated with Infection

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D. Sclerotic Diseases: This means scarring of the glomeruli by various systemic and local causes. Examples: diabetes and lupus disease.

E. Idiopathic: Cause of the disease is unknown.

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How do you Diagnose Glomerulonephritis?

Clinical symptoms and signs Blood investigations(2^✔ ✔Trusted Source
Glomerulonephritis

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• Urine routine examination
• Kidney function tests (haemoglobin, urea, creatinine, sodium, potassium, bicarbonate, total protein, almumin, HIV, HbsAg, HCV)
• 24 hrs urine protein estimation
• Special tests – Antinuclear antibody, complement C3/C4, Antinuclear antibody profile, genetic tests etc.

• Kidney biopsy – After Nephrologist opinion, it is a process by which a small kidney sample is taken under ultrasound guidance with help of a biopsy needle under local anaesthesia and examined in microscope by the trained Kidney pathologist after staining the tissue to give confirmed diagnosis of the type of glomerular disease.

How do you Treat Glomerulonephritis?

Conservative measures:

• Total fluid restriction
• Total salt intake < 5gm/day
• Control of blood pressure
• Diuretics
• Protein intake (as per nephrologist advice)
• Anti proteinuric medications

Medications:

Under special circumstances after confirmation of diagnosis by kidney biopsy (if applicable) to start on steroids, immunosuppressive medications , plasmapheresis as per the treating nephrologist advise.

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What are its Complications?

The Complications of Glomerulonephritis are as follows:(2^✔ ✔Trusted Source
Glomerulonephritis

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• Fluid overload
• Delay in detection and treatment may lead to progression to Chronic kidney disease
• Increased susceptibility to other infections
• Malnutrition
• Cardiovascular morbidity
• Hypertensive retinopathy
• End-stage renal disease
• Malignant hypertension

How do you Prevent Glomerulonephritis?

• Early detection of renal diseases
• Personal hygiene
• Lifestyle modifications
• Early detection of hypertension and diabetes
• Nephrologist advise
• Proper nutritious diet
• Regular excercise