Glomerulonephritis

Glomerulonephritis: Overview

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.

Diagnose your symptoms now!
  • see your health summarized and in detail
  • understand what's happening to your body
  • identify any nutritional deficiencies

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 and 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 and 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 and 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 - Abdomen

Moderate/severe/significant left lumbar pain or mild left lumbar discomfort

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.

Moderate/severe/significant right lumbar pain or mild right lumbar discomfort

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.

Moderate/significant/severe abdominal pain or mild 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

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.

Concerned or curious about your health?  Try The Analyst™
Symptom Entry
Symptom Entry
Diagnosis
Diagnosis
Suggestions
Suggestions
LifeMeter
LifeMeter®
Full Explanations
Explanations
Optional Doctor Review
Review (optional)

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 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.

Report by The Analyst™
Click to see sample report
Health problems rarely occur in isolation or for obvious reasons

Your body is a highly complex, interconnected system.  Instead of guessing at what might be wrong, let us help you discover what is really going on inside your body based on the many clues it is giving.

Our multiple symptom checker provides in-depth health analysis by The Analyst™ with full explanations, recommendations and (optionally) doctors available for case review and answering your specific questions.

KEY

Weak or unproven link: may be a sign or symptom of; may suggest
Weak or unproven link:
may be a sign or symptom of; may suggest
Strong or generally accepted link: is often a sign or symptom of; often suggests
Strong or generally accepted link:
is often a sign or symptom of; often suggests
May be useful: may help with
May be useful:
may help with
Moderately useful: often helps with
Moderately useful:
often helps with
Very useful: is highly recommended for
Very useful:
is highly recommended for