{"id":262,"date":"2018-04-24T09:29:11","date_gmt":"2018-04-24T09:29:11","guid":{"rendered":"http:\/\/edren.org\/ren\/?page_id=262"},"modified":"2024-07-01T13:36:35","modified_gmt":"2024-07-01T13:36:35","slug":"glomerulonephritis","status":"publish","type":"page","link":"https:\/\/edren.org\/ren\/edren-info\/glomerulonephritis\/","title":{"rendered":"Glomerulonephritis"},"content":{"rendered":"<p><img decoding=\"async\" class=\"cke_anchor\" title=\"Anchor\" src=\"data:image\/gif;base64,R0lGODlhAQABAPABAP\/\/\/wAAACH5BAEKAAAALAAAAAABAAEAAAICRAEAOw==\" alt=\"Anchor\" align=\"\" data-cke-realelement=\"%3Ca%20data-cke-saved-name%3D%22top%22%20name%3D%22top%22%3E%3C%2Fa%3E\" data-cke-real-node-type=\"1\" data-cke-real-element-type=\"anchor\" \/>Glomeruli are the filters of our kidneys.\u00a0 We should have about a million in each kidney.\u00a0 They are tiny \u2013 you can fit 10 side by side on the head of a pin.\u00a0 A tube (tubule) leading out of each is actually a processing device from which 99% of the filtered fluid is reprocessed back into the blood, leaving waste products, excess salt and so on to flow out into urine.<\/p>\n<p>So glomeruli filter over 150 litres of blood each day into the tubules, but only 1-2 litres of this remains at the end of all the nephrons to make urine.<\/p>\n<h5><strong><span style=\"color: #993300;\">What happens when glomeruli go wrong?<\/span><\/strong><\/h5>\n<p>Three types of problem:<\/p>\n<p><strong><span style=\"color: #993300;\">1.\u00a0 They leak protein or blood:<\/span><\/strong><\/p>\n<ul style=\"list-style-type: disc;\">\n<li><strong><span style=\"color: #993300;\">Proteinuria<\/span><\/strong> is when protein leaks into the urine; (detailed info about <a href=\"http:\/\/edren.org\/ren\/edren-info\/proteinuria\/\" data-cke-saved-href=\"[wblink159]\">proteinuria<\/a>). The main protein is albumin; so proteinuria may be called albuminuria. When the leak is very severe it causes <a href=\"http:\/\/edren.org\/ren\/edren-info\/nephrotic-syndrome\/\" data-cke-saved-href=\"[wblink153]\">nephrotic syndrome<\/a>.\u00a0 This is when the leak is so large that the levels of protein in the blood fall.\u00a0 This leads to the kidneys retaining salt and fluid, and the excess fluid collects as swelling (oedema) of the ankles and legs, or of the face and abdomen (these last two especially in children).<\/li>\n<li><strong><span style=\"color: #993300;\">Haematuria<\/span><\/strong> means blood in the urine; (detailed info on <a href=\"http:\/\/edren.org\/ren\/edren-info\/haematuria-hematuria\/\" data-cke-saved-href=\"[wblink141]\">haematuria<\/a>). Red blood cells should normally be kept in the blood stream at the filters (glomeruli). When the glomeruli develop big holes, for instance caused by inflammation, they can leak blood. If the blood is visible to the naked eye it is called macroscopic haematuria. Usually it is much less than you can see and is only detected by a urine dipstick test \u2013 this is called microscopic haematuria.<\/li>\n<\/ul>\n<p><strong><span style=\"color: #993300;\">2.\u00a0 High blood pressure:<\/span><\/strong><br \/>\n<a href=\"http:\/\/edren.org\/ren\/edren-info\/high-blood-pressure-hypertension\/\" data-cke-saved-href=\"[wblink144]\">High blood pressure<\/a> occurs in most kinds of glomerulonephritis, and can lead to further kidney damage.<\/p>\n<p><strong><span style=\"color: #993300;\">3.\u00a0 Loss of filtering power:<\/span> <\/strong><br \/>\nIf you lose a few glomeruli, the others can compensate.\u00a0 But if you lose a lot you lose filtering capacity, so your kidneys don\u2019t work properly, and waste products build up in the blood.\u00a0 Filtering capacity is called Glomerular Filtration Rate, GFR.\u00a0 You can lose 75% of filtering capacity before you start to feel unwell from it. A sudden severe reduction in GFR is <a href=\"http:\/\/edren.org\/ren\/edren-info\/acute-renal-failure-aki\/\" data-cke-saved-href=\"[wblink221]\">acute kidney injury (AKI or ARF)<\/a>. Long-term reduced GFR is known as <a href=\"http:\/\/edren.org\/ren\/edren-info\/ckd-chronic-renal-failure-and-its-progression\/\" data-cke-saved-href=\"[wblink133]\">CKD (chronic kidney damage)<\/a>.<\/p>\n<h5><strong><span style=\"color: #993300;\">What can damage glomeruli?<\/span><\/strong><\/h5>\n<ul style=\"list-style-type: disc;\">\n<li>A congenital or inherited problem with some part of the glomeruli.\u00a0 The most common example is <a href=\"http:\/\/edren.org\/ren\/edren-info\/alport-syndrome\/\" data-cke-saved-href=\"[wblink125]\">Alport\u2019s syndrome.<\/a> There are others, usually rare diseases.<\/li>\n<li>Inflammation \u2013 either the kidneys alone or as part of a disease affecting other organs too. See the causes in the next section.<\/li>\n<li>Other problems can disturb some of the very special cells in the glomerulus so that they leak protein.<\/li>\n<li>In diabetes extra material can be deposited in the glomerulus and it doesn\u2019t work properly.<\/li>\n<li>Different causes of damage cause different types of glomerulonephritis.<\/li>\n<\/ul>\n<h5><strong><span style=\"color: #993300;\">What are the common kinds of glomerulonephritis?<\/span><\/strong><\/h5>\n<p>The table shows some of the more common causes of glomerulonephritis (GN).\u00a0 There are some rare kinds too though.<\/p>\n<table border=\"1\" width=\"65%\" cellspacing=\"1\" cellpadding=\"3\" align=\"center\">\n<tbody>\n<tr>\n<td style=\"width: 60%;\"><\/td>\n<td style=\"background-color: #e6f7ed; width: 20%;\" bgcolor=\"#e6f7ed\"><strong><span style=\"color: #993300;\">Proteinuria\u00a0 <\/span><\/strong><\/td>\n<td style=\"background-color: #e6f7ed; width: 20%;\" bgcolor=\"#e6f7ed\"><strong><span style=\"color: #993300;\">Haematuria<\/span><\/strong><\/td>\n<\/tr>\n<tr>\n<td style=\"background-color: #e6f7ed; width: 60%;\" bgcolor=\"#e6f7ed\"><a href=\"http:\/\/edren.org\/ren\/edren-info\/minimal-change-disease\/\" data-cke-saved-href=\"[wblink152]\"><strong>Minimal change<\/strong><\/a> \u2013 Causes most cases of nephrotic syndrome in children but some in adults too. Unlikely to cause renal failure.<\/td>\n<td style=\"text-align: center; width: 20%;\" bgcolor=\"#e6f7ed\"><strong>++++<\/strong><\/td>\n<td style=\"text-align: center; width: 20%;\" bgcolor=\"#e6f7ed\"><strong>&#8211;<\/strong><\/td>\n<\/tr>\n<tr>\n<td style=\"background-color: #e6f7ed; width: 60%;\"><a href=\"http:\/\/edren.org\/ren\/edren-info\/fsgs\/\" data-cke-saved-href=\"[wblink138]\"><strong>Focal and segmental glomerulosclerosis (FSGS)<\/strong><\/a> \u2013 Can cause nephrotic syndrome in adults. Those with other types of FSGS can progress to renal failure.<\/td>\n<td style=\"text-align: center; width: 20%;\" bgcolor=\"#e6f7ed\"><strong>++++<\/strong><\/td>\n<td style=\"text-align: center; width: 20%;\" bgcolor=\"#e6f7ed\"><strong>&#8211;<\/strong><\/td>\n<\/tr>\n<tr>\n<td style=\"background-color: #e6f7ed; width: 60%;\"><a href=\"[wblink151]\" data-cke-saved-href=\"[wblink151]\"><strong>Membranous nephropathy<\/strong><\/a> \u2013 Causes proteinuria or nephrotic syndrome. Cause is usually unknown, but sometimes drugs, other diseases or cancer can cause it. Some cases get better; others deteriorate.<\/td>\n<td style=\"text-align: center; width: 20%;\" bgcolor=\"#e6f7ed\"><strong>+++<\/strong><\/td>\n<td style=\"text-align: center; width: 20%;\" bgcolor=\"#e6f7ed\"><strong>&#8211;<\/strong><\/td>\n<\/tr>\n<tr>\n<td style=\"background-color: #e6f7ed; width: 60%;\"><strong><a href=\"http:\/\/edren.org\/ren\/edren-info\/diabetic-kidney-disease\/\" data-cke-saved-href=\"[wblink136]\">Diabetes<\/a> <\/strong>\u2013 After many years of diabetes the kidneys may start to leak protein.\u00a0 This is more likely to happen if the blood sugar or blood pressure are poorly controlled.<\/td>\n<td style=\"text-align: center; width: 20%;\" bgcolor=\"#e6f7ed\"><strong>+++<\/strong><\/td>\n<td style=\"text-align: center; width: 20%;\" bgcolor=\"#e6f7ed\"><strong>&#8211;<\/strong><\/td>\n<\/tr>\n<tr>\n<td style=\"background-color: #e6f7ed; width: 60%;\"><strong><span style=\"color: #993300;\">Amyloid<\/span> <\/strong>\u2013 Special protein deposited in the kidney. Can cause <a href=\"http:\/\/edren.org\/ren\/edren-info\/nephrotic-syndrome\/\" data-cke-saved-href=\"[wblink153]\">nephrotic syndrome<\/a> and renal failure.<\/td>\n<td style=\"text-align: center; width: 20%;\" bgcolor=\"#e6f7ed\"><strong>++++<\/strong><\/td>\n<td style=\"text-align: center; width: 20%;\" bgcolor=\"#e6f7ed\"><strong>&#8211;<\/strong><\/td>\n<\/tr>\n<tr>\n<td style=\"background-color: #e6f7ed; width: 60%;\"><a href=\"http:\/\/edren.org\/ren\/edren-info\/sle-lupus\/\" data-cke-saved-href=\"[wblink165]\"><strong>Lupus<\/strong><\/a> \u2013 A common cause of glomerulonephritis in young women.\u00a0 Can cause different types of glomerulonephritis.\u00a0 The worst ones need powerful treatment to prevent irreversible kidney damage.<\/td>\n<td style=\"text-align: center; width: 20%;\" bgcolor=\"#e6f7ed\"><strong>++++<\/strong><\/td>\n<td style=\"text-align: center; width: 20%;\" bgcolor=\"#e6f7ed\"><strong>+ to +++<\/strong><\/td>\n<\/tr>\n<tr>\n<td style=\"background-color: #e6f7ed; width: 60%;\"><span style=\"color: #993300;\"><strong><span style=\"color: #993300;\">Mesangio-capillary GN (MCGN) or <\/span><\/strong>\u00a0<strong><span style=\"color: #993300;\">Mesangio proliferative GN,<\/span> <span style=\"color: #993300;\">(MGPN)<\/span><\/strong><\/span>\u2013 Can be caused by persistent infections\u00a0 (e.g. endocarditis, hepatitis B or C), other diseases, or can occur alone.<\/td>\n<td style=\"text-align: center; width: 20%;\" bgcolor=\"#e6f7ed\"><strong>++<\/strong><\/td>\n<td style=\"text-align: center; width: 20%;\" bgcolor=\"#e6f7ed\"><strong>++<\/strong><\/td>\n<\/tr>\n<tr>\n<td style=\"width: 60%;\" bgcolor=\"#e6f7ed\"><a href=\"http:\/\/edren.org\/ren\/edren-info\/iga-nephropathy\/\" data-cke-saved-href=\"[wblink145]\"><strong>IgA<\/strong><\/a> \u2013 Most common cause worldwide (see later text)<\/td>\n<td style=\"text-align: center; width: 20%;\" bgcolor=\"#e6f7ed\"><strong>+\/-<\/strong><\/td>\n<td style=\"text-align: center; width: 20%;\" bgcolor=\"#e6f7ed\"><strong>++<\/strong><\/td>\n<\/tr>\n<tr>\n<td style=\"width: 60%;\" bgcolor=\"#e6f7ed\"><span style=\"color: #993300;\"><strong><span style=\"color: #993300;\">Post-infectious<\/span><\/strong> <\/span>\u2013 Less c<\/p>\n<table border=\"1\" width=\"65%\" cellspacing=\"1\" cellpadding=\"3\" align=\"center\">\n<tbody>\n<tr>\n<td><\/td>\n<td bgcolor=\"#e6f7ed\"><strong><a href=\"http:\/\/edren.org\/ren\/edren-info\/crescentic-nephritis-rpgn\/\" data-cke-saved-href=\"[wblink134]\">Crescentic nephritis<\/a> <\/strong>\u2013 Also known as rapidly progressive GN. A severe and usually very acute type of kidney inflammation that can cause loss of kidney function within days to weeks. It can be caused by several conditions on this list, and a few more.<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<p>ommon now than in the past. Occurs after an infection, often Streptococcal throat or skin infection. Causes with haematuria, proteinuria, high blood pressure, fluid retention, reduced GFR. Usually gets better if the infection clears up.<\/td>\n<td style=\"text-align: center; width: 20%;\" bgcolor=\"#e6f7ed\"><strong>+<\/strong><\/td>\n<td style=\"text-align: center; width: 20%;\" bgcolor=\"#e6f7ed\"><strong>+++<\/strong><\/td>\n<\/tr>\n<tr>\n<td style=\"width: 60%;\" bgcolor=\"#e6f7ed\"><a href=\"http:\/\/edren.org\/ren\/edren-info\/vasculitis\/\" data-cke-saved-href=\"[wblink168]\"><strong>Vasculitis<\/strong><\/a> \u2013 Inflammation of small blood vessels in the glomerulus. Often caused by diseases that affect other organs too e.g. Microscopic polyangiitis, Wegener\u2019s disease. If severe, can cause crescentic nephritis (see text).<\/td>\n<td style=\"text-align: center; width: 20%;\" bgcolor=\"#e6f7ed\"><strong>+<\/strong><\/td>\n<td style=\"text-align: center; width: 20%;\" bgcolor=\"#e6f7ed\"><strong>++++<\/strong><\/td>\n<\/tr>\n<tr>\n<td style=\"width: 60%;\" bgcolor=\"#e6f7ed\"><\/td>\n<td style=\"text-align: center; width: 20%;\" bgcolor=\"#e6f7ed\"><strong>+<\/strong><\/td>\n<td style=\"text-align: center; width: 20%;\" bgcolor=\"#e6f7ed\"><strong>++++<\/strong><\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<h5><strong><span style=\"color: #993300;\">How do you make the diagnosis?<\/span><\/strong><\/h5>\n<p>Sometimes the diagnosis is obvious from blood and urine tests. However other times a kidney biopsy is necessary to take a closer look at the kidney under a microscope.\u00a0 A scanner is used to find the kidney first, then under local anaesthetic a needle is placed into the kidney through the back. A very small sample of the kidney is taken.<\/p>\n<h5><strong><span style=\"color: #993300;\">Can glomerulonephritis be treated?<\/span><\/strong><\/h5>\n<p>Some types of glomerulonephritis can be cured, others can be stopped, and most can at least be slowed down.\u00a0\u00a0 Here are some examples, but click on the links in the table above for more information.<\/p>\n<ul style=\"list-style-type: disc;\">\n<li>Minimal change disease does not cause permanent kidney failure but needs treatment to stop the protein leak.\u00a0 Most types of post-infectious glomerulonephritis get better if the infection does.<\/li>\n<li>Membranous nephropathy can either get better or worse, but can be treated if it gets worse.<\/li>\n<li>Crescentic glomerulonephritis can result in kidney failure very quickly, but this can often be stopped or even reversed by prompt treatment.<\/li>\n<li>Others (see table) can progress over different periods of time.\u00a0 Dialysis or kidney transplantation may eventually be required for some.<\/li>\n<\/ul>\n<h5><strong><span style=\"color: #993300;\">Glomerulonephritis can be treated in two ways:<\/span><\/strong><\/h5>\n<p><strong><span style=\"color: #993300;\">General treatments \u2013 for all types<\/span><\/strong><br \/>\nBlood pressure is often high in patients with kidney disease, and can worsen kidney damage so it is important to treat it.\u00a0 A type of blood pressure drug known as an ACE inhibitor has been proven to be particularly good at protecting kidney function and reducing the amount of protein in the urine, even if blood pressure is not high.\u00a0 Blood pressure should be 130\/75 mmHg or ideally less.\u00a0 Blood pressure may need to be controlled using more than one type of medicine.\u00a0 More info on <a href=\"http:\/\/edren.org\/ren\/edren-info\/blood-pressure-in-kidney-disease\/\" data-cke-saved-href=\"[wblink130]\">blood pressure treatment<\/a> in kidney disease.<\/p>\n<p><strong><span style=\"color: #993300;\">Disease-modifying treatments \u2013 for some types<\/span><\/strong><br \/>\nBecause many types of glomerulonephritis are due to our immune system, treatments can involve drugs that dampen down the immune system and reduce inflammation in the kidney (immunosuppressants). For example, steroids (e.g. prednisolone), cyclophosphamide, azathioprine, ciclosporin and mycophenolate mofetil (MMF). These are strong drugs which can have serious side-effects but which can rescue kidney function in some severe types of glomerulonephritis (e.g. crescentic nephritis).\u00a0 Because of this they are often only used for those patients with severe disease or rapidly worsening kidney function.\u00a0 However steroids alone are used frequently for treatment of minimal change disease as it usually responds fully to treatment (although it may relapse and need re-treatment). More info on <a href=\"http:\/\/edren.org\/ren\/edren-info\/immunosuppressive-drugs-for-renal-disease\/\" data-cke-saved-href=\"[wblink148]\">immune-suppressing drugs and the kidney.<\/a><\/p>\n<h5><strong><span style=\"color: #993300;\">Further info<\/span><\/strong><\/h5>\n<p><a href=\"http:\/\/www.edrep.org\/pages\/textbook\/glomerulonephritis.php\" data-cke-saved-href=\"http:\/\/www.edrep.org\/pages\/textbook\/glomerulonephritis.php\">Glomerulonephritis teaching<\/a> (edrep textbook)<\/p>\n<p>&nbsp;<\/p>\n<p><span style=\"font-size: 12pt;\"><strong>Acknowledgements:<\/strong>\u00a0 The authors of this page were Heather Kerr and Neil Turner. It was first published in July 2009. The date is was last modified is shown in the footer.<\/span><\/p>\n","protected":false},"excerpt":{"rendered":"<p>Glomeruli are the filters of our kidneys.\u00a0 We should have about a million in each kidney.\u00a0 They are tiny \u2013 you can fit 10 side by side on the head of a pin.\u00a0 A tube (tubule) leading out of each is actually a processing device from which 99% of the\u2026<\/p>\n<p> <a class=\"continue-reading-link\" href=\"https:\/\/edren.org\/ren\/edren-info\/glomerulonephritis\/\"><span>Continue reading<\/span><i class=\"crycon-right-dir\"><\/i><\/a> <\/p>\n","protected":false},"author":2,"featured_media":0,"parent":220,"menu_order":153,"comment_status":"closed","ping_status":"closed","template":"","meta":{"_lmt_disableupdate":"","_lmt_disable":"","footnotes":""},"class_list":["post-262","page","type-page","status-publish","hentry"],"_links":{"self":[{"href":"https:\/\/edren.org\/ren\/wp-json\/wp\/v2\/pages\/262","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/edren.org\/ren\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/edren.org\/ren\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/edren.org\/ren\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/edren.org\/ren\/wp-json\/wp\/v2\/comments?post=262"}],"version-history":[{"count":15,"href":"https:\/\/edren.org\/ren\/wp-json\/wp\/v2\/pages\/262\/revisions"}],"predecessor-version":[{"id":940,"href":"https:\/\/edren.org\/ren\/wp-json\/wp\/v2\/pages\/262\/revisions\/940"}],"up":[{"embeddable":true,"href":"https:\/\/edren.org\/ren\/wp-json\/wp\/v2\/pages\/220"}],"wp:attachment":[{"href":"https:\/\/edren.org\/ren\/wp-json\/wp\/v2\/media?parent=262"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}