Glomerulonephritis | Nephrotic | Nephrotic Syndrome

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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• 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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  ).

The early signs of the acute disease are(4^✔ ✔Trusted Source
Epidemiology and clinical outcomes of acute glomerulonephritis in a teaching hospital in North India

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• Generalised edema
• Nephrotic range proteinuria
• Hypoalbuminaemia
• Hypertension
• hematuria
• Loss of glomerular filtration rate

The common symptoms of kidney failure include(5^✔ ✔Trusted Source
Chronic Kidney Disease

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• Lack of appetite
• Nausea and vomiting
• Fatigue
• Difficulty sleeping
• Dry and itchy skin
• Muscle cramps, especially at night.

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.

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.

Acute Form: Treatment to remove excess fluid by diuretics, blood pressure control medications.

After confirming diagnosis by kidney biopsy may need medication like steroids(2^✔ ✔Trusted Source
Glomerulonephritis

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Tacrolimus rescue therapy in resistant or relapsing cases of primary glomerulonephritis

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Antibiotics are not used for acute glomerulonephritis(10^✔ ✔Trusted Source
Antibiotics for acute group A streptococcal pharyngitis

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Chronic Form:

There is no specific treatment for the chronic form of the illness. Your doctor may tell you to:

• Eat less protein, salt and potassium fluid restriction, daily weight monitoring, salt 11^✔ ✔Trusted Source
  Effects of salt restriction on blood volume, hemodynamics and humoral factors in hypertensive patients with chronic glomerulonephritis

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  ), protein intake (0.8G/Kg/Day)(12^✔ ✔Trusted Source
  Dietary protein intake and chronic kidney disease

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  )

• Take diuretics and calcium supplements
• Control your blood pressurewith drugs like ACEi, ARB’s

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

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There are no proven strategies to prevent glomerulonephritis but the behavior patterns and lifestyle modifications that can decrease risk factors can be made, like good hygiene(13^✔ ✔Trusted Source
Poststreptococcal Glomerulonephritis

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If you have the chronic type, it is very important to control your blood pressure since this may slow down kidney damage. Your doctor may tell you to eat less protein.

A dietitian who is trained to work with kidney patients (a renal or kidney dietitian) can be very helpful in planning your diet.

Protein in the diet:

Your body needs protein every day for growth, building muscles and repairing tissue. After your body uses the protein in the foods you eat, a waste product called urea is made.

However to low a protein intake may lead to malnutrition and lower immunity further.

Protein is found in two types of foods:

In large amounts it is found in food from animal sources such as poultry, meat, seafood, eggs, milk, cheese and other dairy products.

In smaller amounts it is found in food from plant sources such as breads, cereals, grains, and some vegetables(14^✔ ✔Trusted Source
Protein for Life: Review of Optimal Protein Intake, Sustainable Dietary Sources and the Effect on Appetite in Ageing Adults

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Consult your doctor if you have any of the above symptoms or family history of kidney diseases for routine screening.