Chronic glomerulonephritis

Definition

Chronic glomerulonephritis is the advanced stage of a group of kidney disorders, resulting in inflammation and slowly worsening destruction of internal kidney structures called glomeruli.

Alternative Names

Causes

Chronic glomerulonephritis occurs when there is slow, progressive destruction of the glomeruli of the kidney, with progressive loss of kidney function. In some cases, the cause is found to be a specific attack to the body's immune system, but in most cases, the cause is unknown. Iit is generally thought that a still-unidentified abnormality of the immune system is to blame.

Damage to the glomeruli affects the kidney's ability to filter fluids and wastes properly. This leads to blood and protein in the urine.

This condition may develop after survival of the acute phase of rapidly progressive glomerulonephritis. In about one-quarter of people with chronic glomerulonephritis there is no prior history of kidney disease, and the disorder first appears as chronic kidney failure.

Glomerulonephritis is among the leading causes of chronic kidney failure and end stage kidney disease. Causes include:

• Diabetic nephropathy/sclerosis
• Focal segmental glomerulosclerosis
• IgA nephropathy (Berger's disease)
• Lupus nephritis
• Membranous glomerulonephritis
• Mesangial proliferative disorder
• Nephritis associated with disorders such as amyloidosis, multiple myeloma, or immune disorders, including AIDS

Symptoms

This condition causes high blood pressure (hypertension) and chronic kidney failure.

Specific symptoms include:

• Blood in the urine (dark, rust-colored, or brown urine)
• Foamy urine

Chronic kidney failure symptoms that gradually develop may include the following:

• Decreased alertness
  • Drowsiness, somnolence, lethargy
  • Confusion, delirium
  • Coma
• Decreased sensation in the hands, feet, or other areas
• Decreased urine output
• Easy bruising or bleeding
• Fatigue
• Frequent hiccups
• General ill feeling (malaise)
• Generalized itching
• Headache
• Increased skin pigmentation -- skin may appear yellow or brown
• Muscle cramps
• Muscle twitching
• Nausea and vomiting
• Need to urinate at night
• Seizures
• Unintentional weight loss

Additional symptoms that may be associated with this disease:

• Blood in the vomit or stools
• Excessive urination
• High blood pressure
• Nosebleed

Exams and Tests

Because symptoms develop gradually, the disorder may be discovered when there is an abnormal urinalysis during a routine physical or during an examination for another, unrelated disorder. It may be discovered as a cause of high blood pressure that is difficult to control.

Laboratory tests may reveal anemia or show signs of reduced kidney functioning, including azotemia. Later, signs of chronic kidney failure may be apparent, including edema .

Tests that may be done include:

• Chest x-ray
• Kidney or abdominal CT scan
• Kidney or abdominal ultrasound
• IVP
• Urinalysis

A kidney biopsy may show one of the forms of chronic glomerulonephritis or scarring of the glomeruli.

This disease may also alter the results of the following tests:

• Albumin
• Abdominal MRI
• Anti-glomerular basement membrane
• BUN
• Complement component 3
• Complement
• Creatinine clearance
• Renal scan
• Total protein
• Uric acid, urine
• Urine concentration test
• Urine creatinine
• Urine RBC
• Urine specific gravity
• Urine protein

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. High blood pressure may be difficult to control, and it is generally the most important aspect of treatment. Various 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 help control of high blood pressure or kidney failure.

Dialysis or kidney transplantation may be necessary to control symptoms of kidney failure and to sustain life.

Support Groups

For information and support, see kidney disease support groups.

Outlook (Prognosis)

The outcome varies depending on the cause. Some types of glomerulonephritis may get better on their own.

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 kidney disease is likely.

The disorder worsens at widely variable rates.

Possible 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

When to Contact a Medical Professional

Call your health care provider if disorders associated with increased risk of chronic 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, and nonsteroidal anti-inflammatory analgesics.