Acute Glomerulonephritis

Glomerulonephritis is a disorder in which the tiny filters in your kidneys, known as the glomeruli, becomes inflamed and injured due to the immune process. The glomeruli are the structures in the kidneys that remove excess fluid, electrolytes and waste from the bloodstream and pass them into your urine. Many cases occur after an infection. The most common bacteria associated with this condition are the pneumococcal and streptococcal bacteria. Acute post-streptococcal glomerulonephritis (APSGN) is the most common of the post-infectious renal diseases in childhood.

This disease, also known as, glomerular disease can be classified as acute (a sudden onset of the disease) or chronic, (coming on gradually). This disorder is seen more frequently in males than in females and its peak age of occurrence is around the 5 to 6 year olds.

Etiology and Causes

APSGN typically occurs a week or two after a streptococcal infection, like strep throat or a skin infection such as impetigo, although that etiology is fairly rare. With an infection, there is an antibody-antigen reaction. This causes inflammation to the glomeruli which results in altered structure and function of this filtering component. Some viruses may trigger glomerulonephritis, such as, the virus known as HIV, Hepatitis B and Hepatitis C virus. Other known causes are Bacterial Endocarditis, Lupus or Vasculitis, Goodpasture Syndrome, and IgA nephropathy.

Signs and Symptoms

The signs and symptoms of this disorder is fever, lethargy, irritability, fatigue (from anemia), hematuria ( blood in the urine), proteinuria (protein in the urine), scanty urine output, headache, high blood pressure, pallor, abdominal discomfort, loss of appetite and vomiting. Facial edema, or swelling, is common which tends to be more prominent in the morning. This edema tends to spread to the extremities and the abdomen during the day.

Diagnostic Test

Most children who develop this disorder are in good health until they experience a bacterial or a viral infection. The onset of this condition appears after a latency period of on the average, 10 days. The child will appear healthy during the latency period and because of that fact, many parents do not see the association between the previous infection and the disorder. The following test will be ordered to help make a definitive diagnosis:

Urinalysis– This test will result in red blood cells, red cell casts and protein in your urine, which is a sign of possible damage to the glomeruli. A finding of white blood cells in your urine is an indicator of infection or inflammation.

Blood tests– Serum creatinine and blood urea nitrogen levels can provide information about kidney impairment and damage. You can expect to see an elevated erythrocyte sedimentation rate and a depressed serum complement level. An elevated anti-streptolysin (ASO) titer and an elevated DNAase B antigen titer are laboratory test specifically designated to detect whether or not a streptococcus infection had occurred.

Imaging test– If your doctor determines that there is evidence of kidney damage, he or she may order diagnostic test that will allow them to visualize your kidneys. Test such as an x-ray, a kidney sonogram or a computerized tomography (CT) scan.

Kidney biopsy– It is common for a kidney biopsy to be ordered to confirm a diagnosis of glomerulonephritis. This test will allow the doctor to determine the cause of the inflammation.

Treatment

The treatment for glomerulonephritis is dependent upon several factors: 1) the underlying cause, 2) whether or not the condition is acute in nature or chronic, and 3) the severity of your signs and symptoms. The primary goal is to prevent further damage to the kidneys. In cases where glomerulonephritis was preceded by a strep infection, many times the body tends to heal itself and no specific treatment may be required.

One of the complications of this disorder is high blood pressure and keeping your blood pressure under control is so important in protecting your kidneys. Your doctor may order blood pressure medication and diuretics to manage your blood pressure and to aid in excreting excess fluid.

When your doctor determines the underlying cause then your treatment will be directed towards the underlying cause. If there is a bacterial infection involved, your doctor may prescribe an antibiotic. If lupus or vasculitis is involved, your doctor may prescribe a corticosteroid and immunosuppressing drugs to control the inflammation. In cases where IgA nephropathy is the underlying cause, doctors have been using fish oil and immunosuppressing drugs, concurrently and this has been successful in certain patients. There is research ongoing regarding fish oil supplements and its effectiveness in treating IgA nephropathy.

Diabetic kidney disease (Nephropathy) is a condition that can develop in patients with diabetes. Maintaining appropriate blood glucose levels and blood pressure can help prevent or slow down kidney damage. When Goodpasture Syndrome is the primary diagnosis that led to acute glomerulonephritis, a procedure known as plasmapheresis is used. This is a blood exchange process that removes antibodies from our blood by removing plasma and replacing the plasma with donated plasma and other fluids.

A complication that can result from glomerulonephritis is acute kidney failure and chronic kidney disease. Kidney failure occurs as the filtering component of your kidney loses its ability to remove waste products and fluids. If your kidney function deteriorates you may require dialysis. With chronic kidney disease, the kidney gradually loses its ability to function properly. When kidneys are functioning at less than 10 percent of normal ability, the patient is classified as having end-stage-kidney disease. At this point, dialysis or a kidney transplant is necessary to sustain life.

Prevention

Although, there might not be any way to prevent most forms of glomerulonephritis, we can offer some recommendations that may be beneficial:

  1. Avoiding high blood pressure can lessen the likeliness of damage to your kidneys from hypertension.
  2. Seek immediate medical attention, if you contract strep throat or impetigo which could have the streptococcus bacteria as the causative agent.
  3. Maintain proper blood glucose levels to prevent diabetic nephropathy
  4. Use of non-steroidal anti-inflammatory drugs (NSAID’s) should be avoided because the anti-prostaglandin action of NSAID’s may cause a decrease in the glomerular filtration rate (which is a precursor, as well as, a component of end-stage renal disease).