Glomerulonephritis - chronic

Alternative names
Chronic glomerulonephritis; Chronic nephritis

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).

Causes, incidence, and risk factors

Chronic glomerulonephritis is caused when there is slow progressive destruction of the glomeruli of the kidney, with progressive loss of kidney function. Some cases are caused by specific stimuli to the body’s immune system, but the precise cause of most is unknown. An as yet undefined abnormality of the immune system is believed to be responsible for most cases. It is a cause of high blood pressure and chronic kidney failure.

Damage to the glomeruli with subsequent inefficient filtering causes blood and protein to be lost in the urine. Because symptoms develop gradually, the disorder may be discovered when there is an abnormal urinalysis during routine physical or examination for unrelated disorders. It may be discovered as a cause of hypertension that is difficult to control.

Glomerulonephritis is among the leading causes of chronic kidney failure and end stage kidney disease. With kidney biopsy, it may be possible to reach a precise diagnosis 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.

It may develop after survival of the acute phase of rapidly progressive glomerulonephritis. In about one-fourth 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 renal failure symptoms that gradually developmay 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       o Drowsiness, somnolence, lethargy       o Confusion, delirium       o 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 in stools

Signs and tests
High blood pressure may be present along with abnormal urinalysis. 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 renal failure may be apparent, including edema, 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 but findings are not specific.  
  • A chest X-ray may show fluid overload.  
  • A kidney biopsy may show one of the forms of chronic glomerulonephritis or non specific 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.

Various antihypertensive 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 aid control of hypertension or kidney failure.

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

Support Groups
For information and support, see kidney disease support groups.

Expectations (prognosis)

The outcome varies depending on the cause. Some types of glomerulonephritis may have spontaneous remission.

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 generally progresses 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.

    Johns Hopkins patient information

    Last revised: December 4, 2012
    by Amalia K. Gagarina, M.S., R.D.

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