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What Is Glomerulonephritis?

The kidneys are made up of millions of nephrons that allow for the removal of extra fluid and waste out of the blood. All these nephrons consist of tiny filters called glomeruli, which remove toxins and fluid from the blood, and tubules that process the removed fluid and turn it into urine.

Glomerulonephritis (pronounced gluh-mare-you-low-nih-fry-tis), also called glomerular disease, is a group of kidney diseases in which the glomeruli of the kidney become damaged and inflamed. Glomerulonephritis makes it hard for the kidneys to work as they should. This commonly results in the loss of protein out of the blood, and both red and white blood cells in addition to protein may leak into the urine. Some people with glomerulonephritis will lose their ability to filter waste and many will retain fluid. Eventually, some people with glomerulonephritis may develop chronic kidney disease (CKD) or end stage renal disease (ESRD) and have to begin a renal replacement therapy such as dialysis.

Causes of glomerulonephritis

Glomerulonephritis can be acute or chronic. With acute glomerulonephritis, symptoms come on suddenly and may be temporary or reversible. Acute glomerulonephritis can come about because of an infection such as strep throat, chickenpox or malaria. Acute glomerulonephritis caused by an infection is called post-infectious glomerulonephritis. In an acute case of glomerulonephritis, the antibodies that are created to get rid of the body’s infection begin to attack the glomeruli.

Studies show that 1 percent of children and 10 percent of adults with acute glomerular disease will develop progressive or chronic glomerular disease, which may lead to kidney failure and end stage renal disease (ESRD). People with acute glomerular disease could also develop other kidney diseases.

With chronic glomerulonephritis, symptoms come about slowly over time. In some cases, doctors cannot pinpoint the specific cause of chronic glomerulonephritis. Other times, chronic glomerulonephritis can be the product of a genetic disorder or an autoimmune disease such as lupus in which the body’s immune system attacks various systems in the body. In addition to lupus, other disorders that can cause glomerulonephritis include:

  • Focal segmental glomerulosclerosis
    Scar tissue forms in the filtering units of the kidneys or glomeruli, making it hard for the kidneys to function like they should.
  • Diabetes
    A disease that affects your body’s ability to produce or use insulin and the most common cause of kidney failure requiring dialysis in the United States. There are two main types of diabetes: Type 1 and Type 2.
  • Goodpasture’s syndrome
    An autoimmune disorder that affects the kidneys and lungs, often leading to kidney failure and lung disease.
  • IgA nephropathy
    A kidney disease caused by inflammation of the glomeruli that causes blood in the urine. Also known as Berger’s disease.
  • Membranoproliferative GN I
    A kidney disorder marked by inflammation and changes in the structure of the kidney cells. Also known as MPGN I.
  • Membranoproliferative GN II
    A disease marked by deposits that build up in the kidneys and scar them so they are unable to function properly. Also known as dense deposit disease or MPGN II.
  • Post-streptococcal GN
    A kidney disorder that happens after someone is infected with certain kinds of streptococcus bacteria, the bacteria that cause strep throat or skin infections. The glomeruli become inflamed and unable to work correctly.

Symptoms of glomerulonephritis

Chronic glomuerulonephritis often causes mild symptoms that may not even be noticed for a while. However, as the disease progresses and causes the kidneys to fail, symptoms may grow worse. Studies show that 50 percent of people experience a sickness that resembles the flu in the weeks before their kidneys fail.

Initial symptoms of glomerular disease may include:

  • Swollen feet and legs
  • Puffy face and eyes
  • Decrease in urine production
  • Bubbly, cloudy or bloody urine
  • Nausea

As the disease gets worse, more advanced symptoms may include:

  • Shortness of breath
  • Weakness
  • Fatigue
  • Fever
  • High blood pressure
  • Loss of appetite
  • Abdominal pain
  • Headaches
  • Visual disturbances
  • Seizures

Diagnosing glomerulonephritis

Glomerulonephritis can be discovered during a routine check-up or physical or it can be discovered during tests linked to its symptoms. Because a person can have glomerulonephritis without experiencing any symptoms at first, it is possible for a doctor to stumble upon it unexpectedly through an irregular outcome of a urine or blood test. On the other hand, if people go to their doctors because they have lost their appetite and have swollen feet, a doctor may test specifically for glomerulonephritis.

People with glomerulonephritis often have protein or blood in their urine. They may also have increased levels of serum creatinine, a waste product that comes from muscle activity, in their blood. When kidneys are functioning, they remove creatinine from the blood. As kidney function slows, blood levels of creatinine rise.

Glomerulonephritis can be diagnosed by testing a person’s urine and blood. If someone has progressive glomerulonephritis, a doctor will be able to see red or white blood cells in the person’s urine when it is looked at with a microscope. Once a doctor has the results of the blood and urine tests, he or she can calculate the patient’s glomerular filtration rate (GFR) to measure a person’s kidney function.

A mathematical equation is used to estimate the GFR. In addition to serum creatinine, other factors in the equation include age, race and gender. Sometimes, optional factors such as weight, blood urea nitrogen (BUN) and serum albumin are used to get the patient's GFR level.

Sometimes a doctor may want to do an image scan of the kidneys or a kidney biopsy if he or she suspects glomerulonephritis. All of these tests will help the doctor determine how far the disease has progressed, if it is reversible and the treatment plan.

Treating glomerulonephritis

In some cases, glomerulonephritis may be so mild that treatment isn’t necessary. In these cases, a doctor may simply continue to monitor the situation. Severe, acute glomerulonephritis caused by an infection of some kind may be treated with diet changes and a combination of medicines, including antibiotics to treat the infection, blood pressure medicines and immunosuppressant drugs.

Chronic glomerulonephritis is also treated with immunosuppressant drugs given intravenously or by mouth if the condition is caused by an autoimmune disease. Medicine may also be given to remove antibodies from the blood that could be attacking the kidneys. High blood pressure medicines such as angiotensin-converting enzyme (ACE) inhibitors and angiotensin II receptor blockers (ARBs) may also be taken to help slow the progression of glomerulonephritis. Doctors may also recommend reducing sodium, potassium and protein intake to reduce the amount of work the kidneys have to do.

About 75 percent of people with acute or chronic glomerular disease who are treated within the first few weeks or months of the disease preserve their kidney function. However, detecting the disease in the early weeks or months is often not easy because the symptoms are so mild. In many cases, the disease is not discovered until kidney failure has already begun.

A person’s ability to recover from glomerulonephritis also has to do with the cause of the disease, the person’s age and any other health conditions he or she may have. A kidney transplant may be a viable treatment option for someone with glomerulonephritis whose kidneys have failed, but the disease could return in a transplanted kidney.

Summary

Glomerulonephritis or glomerular disease is a kidney disease that can damage the kidneys and lead to end stage renal disease (ESRD) and dialysis. If you think you are at risk for glomerulonephritis or are experiencing symptoms of this disease, talk to your doctor. The earlier the disease is found, the better the chances of treating it and preserving kidney function.

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