A group of kidney diseases caused by inflammation of the internal kidney structures (glomeruli).

Causes, incidence, and risk factors

Glomerulonephritis may be a temporary and reversible condition or may be progressive resulting in destruction of the kidney glomeruli and chronic renal failure and end stage renal disease. The disease may be caused by specific problems with the body's immune system, but the precise cause of most cases is unknown. Damage to the glomeruli with subsequent impaired filtering causes blood and protein to be lost in the urine. Because symptoms develop gradually, the disorder may be discovered when there is an abnormal urinalysis during routine physical or examination for unrelated disorders. It can cause hypertension and may only be discovered as a cause of hypertension that is difficult to control. It may develop after survival of the acute phase of rapidly progressive glomerulonephritis . In about one-fourth of people with chronic glomerulonephritis , there is no prior history of kidney disease , and the disorder first appears as chronic renal failure. Specific disorders that are associated with glomerulonephritis include:

focal segmental glomerulosclerosis

(FSG)

Goodpasture's syndrome

IgA nephropathy

IgM mesangial proliferative glomerulonephritis

lupus nephritis

membranoproliferative GN I

membranoproliferative GN II

post-streptococcal GN

rapidly progressive (crescentic) glomerulonephritis

rapidly progressive glomerulonephritis (RPGN)

Signs and tests

High blood pressure

may be present along with abnormal

urinalysis . Laboratory tests may reveal anemia or indicate reduced kidney functioning, including azotemia (accumulation of nitrogenous wastes such as creatinine and urea). Later, signs of chronic renal failure may be apparent, including edema , polyneuropathy, and signs of fluid overload including abnormal heart and lung sounds.

A urinalysis may show blood,

casts , protein , or some other abnormality.

Findings on kidney or

abdominal ultrasound , kidney or abdominal CT scan , or IVP are non-specific.

A

chest X-ray may show fluid overload.

A

kidney biopsy may show one of the forms of chronic glomerulonephritis or non specific scarring of the glomeruli. This disease may also alter the results of the following tests:

urine specific gravity

urine concentration test

uric acid, urine

total protein

RBC; urine

protein, urine

creatinine clearance

creatinine - urine

complement component 3

complement

BUN

anti-glomerular basement membrane

albumin

Treatment

Treatment varies depending on the cause of the disorder, and the type and severity of symptoms. The primary treatment goal is control of symptoms.

Hypertension may be difficult to control, and it is generally the most important aspect of treatment. Various antihypertensive medications may be used to attempt to control high blood pressure . Corticosteroids, immunosuppressives, or other medications may be used to treat some of the causes of chronic glomerulonephritis . Dietary restrictions on salt, fluids, protein , and other substances may be recommended to aid control of hypertension or renal failure . Dialysis or kidney transplantation may be necessary to control symptoms of renal failure and to sustain life. The stress of illness can often be helped by joining support groups where members share common experiences and problems. See kidney disease - support group .

Expectations (prognosis)

The outcome varies depending on the cause. Some disorders may have spontaneous remission. If nephrotic syndrome is present and can be controlled, other symptoms may be controlled. If nephrotic syndrome is present and cannot be controlled, end-stage renal disease may result. The disorder generally progresses at widely variable rates.

Complications

nephrotic syndrome

acute nephritic syndrome

chronic renal failure

end-stage renal disease

hypertension

malignant hypertension

fluid overload--congestive

heart failure , pulmonary edema

chronic or recurrent urinary tract infection

increased susceptibility to other infections

Calling your health care provider

Call your health care provider if disorders associated with increased risk of glomerulonephritis are present, or if symptoms indicating glomerulonephritis develop.

Prevention

There is no specific prevention for most cases of chronic glomerulonephritis . Some cases may be prevented by avoiding or limiting exposure to organic solvents, mercury , non-steroidal anti-inflammatory analgesics, and HIV disease .