 |
 |
 |
|
Glomerulonephritis refers to the condition in which the glomeruli (tiny filters in your kidney which help clean the blood) become inflamed and are unable to carry out their filtering functions.
The most common form of glomerulonephritis is believed to be IgA Nephropathy (IgAN or Berger's Disease) - an immune complex disorder which causes IgA immune complexes to be deposited in the glomeruli, where they cause inflammation (glomerulonephritis) and eventual scarring (glomerulosclerosis). IgAN is, however, not the most common cause of end-stage renal disease. According to some estimates, IgAN accounts for only about 10% of end-stage renal failure.
IgA Nephropathy can present as an acute or a chronic form, and in some cases can progress rapidly. The majority of patients have the less aggressive chronic form, which may or may not progress to end-stage renal disease (ESRD) over many years (10 to 25 or more). In the small number of patients who have the rapidly-progressive form, it can lead to ESRD within 5 years.
Causes & Development
What happens in cases of Glomerulonephritis? In any infection, human body identifies the structure of microorganism as antigen. Against the antigen, body produces antibodies (protective against infection). Antibodies identify the antigen and combine with antigen and destroy the microorganisms.
Sometimes antigen structure is similar to glomerulus. The antibodies formed against bacteria, viruses mistake glomerulus as foreign material and begin to attack it. This is one type of glomerulonephritis.
In another type kidney (nephrons) filter blood, remove all waste products form blood and excretes in urine. When kidney filters blood antigen-antibody complex deposit in nephrons and initiates inflammation.
Signs & Symptoms
There are usually no visible symptoms, and the patient is totally unaware that anything is wrong. The blood in the urine is in the form of microscopic hematuria, which means that it is not visible to the naked eye. Particularly amongst adults, the blood is first detected in the urine during a routine medical examination (for example work or insurance-related).
Diagnosis & Tests
Although other kidney diseases may have similar symptoms, it is common to at least suspect IgAN when both protein and blood are found in the urine (especially when occurring in conjunction with an upper respiratory infection.)
|
|
 |
|
 |
Signs, symptoms & indicators of Glomerulonephritis: | | | | | Symptoms - Abdominal Pain |  Pain at side(s) of abdomen | Flank pain may or may not be due to stretching of the renal capsule (the covering that forms the outside of the kidney), or to irritation of the muscle tissues surrounding the kidneys. This flank pain is usually reported as a dull ache. A very small percentage of patients seem to develop persistent, severe attacks of flank pain. |
 (Severe) pain under right side of ribs| | Flank pain may or may not be due to stretching of the renal capsule (the covering that forms the outside of the kidney), or to irritation of the muscle tissues surrounding the kidneys. This flank pain is usually reported as a dull ache. A very small percentage of patients seem to develop persistent, severe attacks of flank pain. |
(Severe) abdominal discomfort| | This occurs in a minority of patients, especially in conjunction with an episode of macro-hematuria. |
|
Symptoms - General |
Constant fatigue| | Many patients with even mild IgAN report extreme fatigue. |
|
Symptoms - Skeletal |
Joint pain/swelling/stiffness |
Symptoms - Urinary |
Having foamy urine| | IgAN is suspected when protein and blood (visible or not) are found in the urine, and is ultimately diagnosed by biopsy. Acute IgAN is often accompanied by heavy proteinuria. Protein in the urine is not visible as such, but unusually foamy urine is often a clue to its presence. |
(Recent onset) blood in urine| | For some patients, IgAN first appears as an acute glomerulonephritis with macroscopic hematuria (visible blood in the urine). In this case patients are visibly sick enough to seek medical attention, and may exhibit any or all the symptoms of acute glomerulonephritis. |
|
| | | | |
Conditions that suggest Glomerulonephritis: | | | | | Circulation | Hypertension (High Blood PRessure)| | As IgAN progresses, it is common for patients to develop high blood pressure. It is very important to treat hypertension by whatever means are necessary, because hypertension itself greatly increases the risk of progressing to end-stage renal disease. |
|
Organ Health |
Nephrotic Syndrome| | If proteinuria is heavy enough, patients will begin to show symptoms of nephrotic syndrome. Nephrotic syndrome is not a disease in itself, but a group of symptoms which are caused by the heavy loss of protein in the urine.
The majority of IgAN patients do not develop nephrotic syndrome, but it is fairly common in pediatric IgAN. |
Chronic Renal Insufficiency| | With about a million glomeruli in each kidney, there is an ample reserve of kidney function, and a person can go many years or even decades without feeling the effects of renal failure. However, once a glomerulus is damaged, it cannot be repaired. IgAN progressively destroys these glomeruli. As more and more glomeruli become scarred and non-functional, the remaining ones start working harder (a process called hyperfiltration), and eventually, as more and more of them fail at an increasingly faster rate, the kidneys no longer have enough function left to perform their task of filtering waste products from the blood. |
|
| | | | |
Recommendations and treatments for Glomerulonephritis: | | | | | Diet |  Reduced Protein Diet| | A low-protein diet is almost essential for patients who have more advanced renal failure (often referred to as pre-ESRD). However, the use of a low-protein diet in mild to moderate IgAN is controversial, as there is no solid evidence that it has any value at all and, in some cases, it can actually be harmful. A nephrologist will determine whether this is necessary.
WARNING
You need instruction from a renal dietician to be on a low protein renal diet, as there is much more to it than merely cutting back on protein. Also, contrary to what many would assume, a low protein diet is not a synonym for a vegetarian diet. There is always a risk of malnutrition with low protein diets. Malnutrition may be hard to reverse in more advanced renal failure. Whatever you do, do not embark on a low protein diet, vegetarian or otherwise, without checking with your nephrologist first as this is one area where you can actually make things worse. Patients with nephrotic syndrome may actually need supplementary protein. Lowering your dietary protein does not necessarily have a significant influence on proteinuria. |
Alcohol Avoidance| | Opinions vary on this subject but, generally speaking, patients may be advised to drink alcohol only moderately. Heavy drinking is injurious to the kidneys and may actually worsen IgAN. |
|
Drug |
 Conventional Drug Use| | Acute IgAN may be treated with oral steroids.
Impaired kidneys are very good at secreting a hormone which deliberately raises blood pressure. It is imperative that any treatment for controlling high blood pressure be followed rigorously, as high blood pressure itself further adds to the damage being caused in the kidneys, and it is an independent risk factor for ESRD (not to mention other cardiovascular complications). In addition to lowering blood pressure, some specific high BP medications appear to have renal-protective and/or antiproteinuric effects. |
|
Habits |
Tobacco Avoidance| | There is steadily increasing evidence that smoking directly contributes to damaging the delicate blood vessels that form the glomeruli, even in people who do not have a chronic kidney disease. |
 Aerobic Exercise| | If there are no other medical contraindications to exercise, nephrologists usually recommend a moderate-to-vigorous exercise program that stimulates the cardiovascular system, such as walking, swimming or cycling (stationary or otherwise). Because high-impact exercise can worsen proteinuria and/or hematuria, if applicable, you may be advised to avoid those (unlikely unless your proteinuria is heavy or your hematuria is visible). You may be advised against heavy contact sports, due to the possibility of an impact that might cause direct injury to a kidney. |
|
Mineral |
Salt Intake Reduction| | If you have IgAN with hypertension or edema, you may be asked to reduce sodium intake. An actual 'renal diet' (low protein, low potassium, low sodium, low phosphorus, high calories) is not required until IgAN has progressed to more advanced renal failure. The purpose of such a renal diet is not to delay progression of IgAN, but mainly to minimize the uremic symptoms of chronic renal failure. |
|
Vitamins |
Vitamin E| | The evidence in favor of vitamin E for kidney diseases in general is not strong, but there are some studies which suggest that the antioxidant effect of vitamin E may be beneficial in cases of chronic kidney disease. The usual dose is one 400 IU capsule per day. Vitamin E is also sometimes "prescribed" for people with more advance renal failure who experience leg and foot cramps. The evidence supporting this use is not strong either, but it is commonly used for this purpose. |
|
| | | | |
KEY | | Weak or unproven link | | | Strong or generally accepted link | | | May do some good | | | Likely to help | | | Highly recommended |
GLOSSARY
Acute
An illness or symptom of sudden onset, which generally has a short duration.
Antibody (Antibodies)
A type of serum protein (globulin) synthesized by white blood cells of the lymphoid type in response to an antigenic (foreign substance) stimulus. Antibodies are complex substances formed to neutralize or destroy these antigens in the blood. Antibody activity normally fights infection but can be damaging in allergies and a group of diseases that are called autoimmune diseases.
Antigen (Antigenic, Antigens)
A substance, usually protein or protein-sugar complex in nature, which, being foreign to the bloodstream or tissues of an animal, stimulates the formation of specific blood serum antibodies and white blood cell activity. Re-exposure to similar antigen will reactivate the white blood cells and antibody programmed against this specific antigen.
Antioxidant (Antioxidants)
A chemical compound that slows or prevents oxygen from reacting with other compounds. Antioxidants are substances that protect cells from oxidative damage caused by molecules called free radicals. These chemicals can damage important parts of cells, such as proteins, membranes, and DNA. Some antioxidants have been shown to have cancer-protecting potential because they neutralize free radicals. Examples include vitamins C and E, beta carotene, the minerals selenium and germanium, superoxide dismutase (SOD), coenzyme Q10, catalase, and some amino acids.
Bacteria (Bacterial, Bacterium)
Microscopic germs. Some bacteria are "harmful" and can cause disease, while other "friendly" bacteria protect the body from harmful invading organisms.
Biopsy
Removal of a sample of tissue from a living being for diagnosis. A pathologist later uses a microscope to look for certain features, such as cancer cells, in the sample. A fine-needle aspiration biopsy involves inserting a thin needle to remove a small amount of tissue, sometimes using CT or ultrasound to guide the needle. A core biopsy involves obtaining a sample of tissue with a thick needle or by inserting a thin, lighted tube (laparoscope) into a small incision in the abdomen. Another biopsy method is to remove tissue during an operation.
Cardiovascular
Pertaining to the heart and blood vessels.
Chronic (Chronicity)
Usually referring to chronic illness: Illness extending over a long period of time.
Chronic Renal Failure (Chronic Renal Insufficiency, Kidney Failure, Renal Insufficiency)
(CRF) Irreversible, progressive impaired kidney function. The early stage, when the kidneys no longer function properly but do not yet require dialysis, is known as Chronic Renal Insufficiency (CRI). CRI can be difficult to diagnose, as symptoms are not usually apparent until kidney disease has progressed significantly. Common symptoms include a frequent need to urinate and swelling, as well as possible anemia, fatigue, weakness, headaches and loss of appetite. As the disease progresses, other symptoms such as nausea, vomiting, bad breath and itchy skin may develop as toxic metabolites, normally filtered out of the blood by the kidneys, build up to harmful levels. Over time (up to 10 or 20 years), CRF generally progresses from CRI to End-Stage Renal Disease (ESRD, also known as Kidney Failure). Patients with ESRD no longer have kidney function adequate to sustain life and require dialysis or kidney transplantation. Without proper treatment, ESRD is fatal.
Cramp (Cramping, Cramps)
A sudden, involuntary, painful muscular contraction.
Edema
Abnormal accumulation of fluids within tissues resulting in swelling.
Glomeruli (Glomerulus)
Tiny tufts of capillaries which carry blood within the kidneys. The blood is filtered by the glomeruli. The blood then continues through the circulatory system, but a certain amount of fluid and specific waste products are filtered out of the blood, to be removed from the body in the form of urine.
Glomerulonephritis
Inflammation of glomerulus. The glomerulus is part of a nephron, which in turn is the basic functional (working) unit of a kidney. Millions of nephrons acting together filter the blood to produce urine.
Hematuria
Blood in the urine.
Hormones (Hormone)
Chemical substances secreted by a variety of body organs that are carried by the bloodstream and usually influence cells some distance from the source of production. Hormones signal certain enzymes to perform their functions and, in this way, regulate such body functions as blood sugar levels, insulin levels, the menstrual cycle, and growth. These can be prescription, over-the-counter, synthetic or natural agents. Examples include adrenal hormones such as corticosteroids and aldosterone; glucagon, growth hormone, insulin, testosterone, estrogens, progestins, progesterone, DHEA, melatonin, and thyroid hormones such as thyroxine and calcitonin.
Hypertension
High blood pressure. Hypertension increases the risk of heart attack, stroke, and kidney failure because it adds to the workload of the heart, causing it to enlarge and, over time, to weaken; in addition, it may damage the walls of the arteries.
Immunoglobulin A (IgA)
Supports mucosal immunity.
IU (mIU, uIU)
International Unit: An arbitrarily defined but agreed upon unit that depends on what is being measured.
mIU: 0.001 or one thousandth of an IU.
uIU: 0.000001 or one millionth of an IU.
Kidneys (Kidney, Renal)
Bean-shaped organs, each about the size of a fist. They are located near the middle of the back, just below the rib cage. The kidneys are sophisticated reprocessing machines, each day handling about 50 gallons of blood to sift out about half a gallon of waste products and extra water. The waste and extra water become urine, which flows to the bladder through tubes called ureters. The actual filtering occurs in tiny units inside the kidneys called nephrons. Every kidney has about a million nephrons. In a nephron, a glomerulus -- which is a tiny blood vessel, or capillary -- intertwines with a tiny urine-collecting tube called a tubule. A complicated chemical exchange takes place, as waste materials and water leave your blood and enter your urinary system. The kidneys recycle chemicals such as sodium, phosphorus, and potassium and thus regulate their levels. Renal: Pertaining to the kidneys.
Phosphorus
The second most abundant mineral in the body, found in every living cell. It is involved in the proper functioning of both muscles and nerves. It is needed for metabolic processes of all cells, to activate many other nutrients, and to form energy-storage and energy-releasing compounds. The phosphorus content of the body is approximately 1% of total body weight. Phosphorus combines with fats to form phospholipids. Combined with calcium, it gives strength and rigidity to the bones and teeth.
Potassium
A mineral that serves as an electrolyte and is involved in the balance of fluid within the body. Our bodies contain more than twice as much potassium as sodium (typically 9oz versus 4oz). About 98% of total body potassium is inside our cells. Potassium is the principal cation (positive ion) of the fluid within cells and is important in controlling the activity of the heart, muscles, nervous system and just about every cell in the body. Potassium regulates the water balance and acid-base balance in the blood and tissues. Evidence is showing that potassium is also involved in bone calcification. Potassium is a cofactor in many reactions, especially those involving energy production and muscle building.
Protein (Proteins)
Compounds composed of hydrogen, oxygen, and nitrogen present in the body and in foods that form complex combinations of amino acids. Protein is essential for life and is used for growth and repair. Foods that supply the body with protein include animal products, grains, legumes, and vegetables. Proteins from animal sources contain the essential amino acids. Proteins are changed to amino acids in the body.
Proteinuria
The presence of protein in the urine, sometimes a symptom of kidney compromise.
Sodium
An essential mineral that our bodies regulate and conserve. Excess sodium retention increases the fluid volume (edema) and low sodium leads to less fluid and relative dehydration. The adult body averages a total content of over 100 grams of sodium, of which a surprising one-third is in bone. A small amount of sodium does get into cell interiors, but this represents only about ten percent of the body content. The remaining 57 percent or so of the body sodium content is in the fluid immediately surrounding the cells, where it is the major cation (positive ion). The role of sodium in the extracellular fluid is maintaining osmotic equilibrium (the proper difference in ions dissolved in the fluids inside and outside the cell) and extracellular fluid volume. Sodium is also involved in nerve impulse transmission, muscle tone and nutrient transport. All of these functions are interrelated with potassium.
Steroid (Steroids)
Any of a large number of hormonal substances with a similar basic chemical structure containing a 17-carbon 14-ring system and including the sterols and various hormones and glycosides.
Syndrome
A medical condition characterized by a collection of related symptoms (what the patient feels) and signs (what a doctor can observe or measure).
Vegetarian (Lacto-Ovo-Vegetarian, Vegetarianism, Vegetarians)
A person who consumes no meat, fish or fowl (chicken, turkey, etc.), but who may consume animal products such as dairy products (milk, cheese, butter, etc.), eggs or honey.
Virus (Viri, Viruses)
Any of a vast group of minute structures composed of a protein coat and a core of DNA and/or RNA that reproduces in the cells of the infected host. Capable of infecting all animals and plants, causing devastating disease in immunocompromised individuals. Viruses are not affected by antibiotics, and are completely dependent upon the cells of the infected host for the ability to reproduce.
Vitamin E
An essential fat-soluble vitamin. As an antioxidant, helps protect cell membranes, lipoproteins, fats and vitamin A from destructive oxidation. It helps protect red blood cells and is important for the proper function of nerves and muscles. For Vitamin E only, 1mg translates to 1 IU.
Last updated: Mar 24, 2009
|
 |
|
|
