Glomerulonephritis

Glomerulonephritis (GN) is a kidney disease caused by inflammation of small filters in the kidney (known as glomeruli). Glomeruli remove excess waste and fluid from bloodstream into urine. Patients with glomerulonephritis lose this important kidney function either because of a sudden onset (acute) or a gradual onset (chronic) of glomeruli inflammation.

There are four major types of glomerulonephritis:

• IgA Nephropathy
• Focal Segmental Global Sclerosis (FSGC)
• Membranous Glomerulonephritis
• Lupus Nephritis (Renal Disease in Systemic Lupus Erythematosus)

There are various causes of Glomerulonephritis, and many involve abnormalities in the immune responsiveness.

• Specific immune system problems (autoimmune diseases) such as IgA nephropathy may also lead to GN, which results from deposits of an antibody (immunoglobulin A) in the glomeruli that triggers inflammation. The exact mechanism of IgA nephropathy is not fully understood, and the disease can develop gradually for years before it can be detected.
  • Primary glomerulonephritis affects the kidneys directly
  • Secondary glomerulonephritis is the kidney manifestation of a condition that affects the whole body (e.g. SLE, viral hepatitis, diabetes mellitus, hypertension)
  • Glomerular diseases can be acute (e.g. lupus nephritis, ANCA associated glomerulonephritis, anti-GBM disease) or chronic (e.g. IgA nephropathy), and can be relapsing (e.g. lupus nephritis, minimal change disease)

Symptoms may include any of the following, but discomfort may occur only very late in the course of the disease:

• Urine colour changes to dark or pink
• Foamy urine due to protein in urine
• Headache, sickness, fever and chills
• High blood pressure
• Reduced urine production
• Swelling of legs, hands and face due to excess fluid retention and / or low albumin level in blood

Treatments can be categorized into disease-specific or general measures to protect viable kidney tissue.

Examples include:

• Medicines to control blood pressure and reduce urine protein excretion
• Immunosuppressive / immunomodulatory agents in immune-mediated kidney diseases
• Dietary modifications, which may include control of salt and water intake to reduce fluid retention

Patients with progressive chronic kidney disease need to consider and prepare for renal replacement therapies such as dialysis or kidney transplantation.