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Monday, February 18, 2008

Chronic glomerulonephritis

Definition:

Chronic glomerulonephritis is the advanced stage of a group of kidney disorders, resulting in inflammation and gradual, progressive destruction of the glomeruli (internal kidney structures).

Alternative Names:

Glomerulonephritis - chronic; Chronic nephritis

Causes, incidence, and risk factors:

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 (it is generally thought that a still-unidentified abnormality of the immune system is to blame). This condition causes high blood pressure (hypertension) and chronic kidney failure .
Damage to the glomeruli means that the kidneys don't filter properly. This results in blood and protein in the urine. 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.
Glomerulonephritis is among the leading causes of chronic kidney failure and end stage kidney disease. If a kidney biopsy is performed early on, it may be possible to reach a precise diagnosis of the cause, such as membranous glomerulonephritis , IgA nephropathy (Berger's disease) , focal segmental glomerulosclerosis , mesangial proliferative disorder, diabetic nephropathy/sclerosis , lupus nephritis , or nephritis associated with disorders such as amyloidosis , multiple myeloma , or immune disorders including AIDS .
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.

Symptoms:

  • Blood in the urine (dark, rust-colored, or brown urine)
  • Foamy urine
Chronic kidney failure symptoms that gradually develop may include the following:
  • Unintentional weight loss
  • Nausea and vomiting
  • General ill feeling (malaise)
  • Fatigue
  • Headache
  • Frequent hiccups
  • Generalized itching
  • Decreased urine output
  • Need to urinate at night
  • Easy bruising or bleeding
  • Decreased alertness
    • Drowsiness , somnolence , lethargy
    • Confusion , delirium
    • Coma
  • Muscle twitching
  • Muscle cramps
  • Seizures
  • Increased skin pigmentation -- skin may appear yellow or brown
  • Decreased sensation in the hands, feet, or other areas
Additional symptoms that may be associated with this disease:
  • Excessive urination
  • Nosebleed
  • High blood pressure
  • Blood in the vomit or stools

Signs and tests:

There may be high blood pressure and a urinalysis may be abnormal. 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 kidney failure may be apparent, including edema (swelling), polyneuropathy, and signs of fluid overload including abnormal heart and lung sounds.
  • A urinalysis may show blood, casts , protein , or some other abnormality.
  • Kidney or abdominal ultrasound , kidney or abdominal CT scan , or IVP may show small kidneys.
  • A chest x-ray may show fluid overload.
  • 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:
  • Urine specific gravity
  • Urine concentration test
  • Uric acid, urine
  • Total protein
  • Renal scan
  • Urine RBC
  • Urine protein
  • Creatinine clearance
  • Urine creatinine
  • Complement component 3
  • Complement
  • BUN
  • Anti-glomerular basement membrane
  • Albumin
  • Abdominal MRI

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. Current therapy includes aggressive treatment of high blood pressure with ACE inhibitors or angiotensin receptor blockers to slow the progression of kidney failure.
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,

Expectations (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.

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 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.

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