Glomerulonephritis (acute, chronic): what it is, symptoms and more

What is Glomerulonephritis?

Glomerulonephritis or nephritis is a glomerulopathy , that is, a disease  that affects the  glomeruli . These small microscopic structures are inside the kidneys and are the parts of the organ that filter the blood, removing impurities from it and transforming them into the glomerular filtrate, which will later be converted into urine by other parts of the kidney.

When the glomeruli become inflamed, the inflammation is called glomerulonephritis.

The condition can be acute or chronic. When acute, it usually has an infectious cause, although it may be related to other problems, such as autoimmune diseases . The chronic one, on the other hand, tends to have a genetic origin.

The disease has several different types and in aggressive cases it can cause kidney failure and failure. Hemodialysis and transplantation may be necessary in some cases, but in general, the body can adapt to the condition before symptoms appear.

When symptoms appear, the disease is usually advanced. They are not particularly uncomfortable, but they can be easily identified and, if they do, consulting a general practitioner or nephrologist is important.

How do the kidneys perform blood filtration?

It is common knowledge that the kidneys filter the blood, but stopping to think, you know how to say? After all, how do the glomeruli participate in this process?

Glomeruli are microscopic structures that lie inside the bowman’s capsules , small pockets located inside the kidneys. Each capsule has a glomerulus and there are approximately one million of them per kidney.

To bring blood to these bags, the body uses arteries. These divide into arterioles (small arteries), which within the capsules divide even more, transforming into several glomerular capillaries .

This capillary structure, added to the space inside the bowman capsule and the duct with which the capsule connects, is the glomerulus. During a glomerulonephritis, it becomes inflamed.

Glomerular capillaries have several filtration barriers on their walls. These barriers prevent blood cells and proteins from passing, but everything else is released.

What passes through the filtration barriers (that is, everything that is not protein and blood cells) is inside the bowman’s capsule, but outside the capillaries. This is the glomerular filtrate . It consists of water, urea, electrolytes, glucose and a small amount of proteins that may have managed to pass through the barrier.

From the bowman capsule, the filtrate goes to the renal tube. It is where the filtrate is converted into urine.

Meanwhile, the capillaries turn into an arteriole only again. The blood cells and proteins move on to the circulation, with the blood already filtered.

Types

Glomerulonephritis can be divided into primary and secondary, according to the cause of the problem, in addition to being classified as acute or chronic.

Primary

In primary glomerulonephritis the cause directly affects the glomeruli and kidneys. This type of illness is usually caused by infections, such as viruses and bacteria that spread through the body and reach the kidneys. However, this is not the only way to achieve primary glomerulonephritis.

The types are as follows:

  • Post-streptococcal acute diffuse glomerulonephritis;
  • Membranous glomerulonephritis;
  • Glomerulonephritis due to minimal injuries;
  • Segmental and focal glomerulonephritis;
  • Rapidly progressive glomerulonephritis (GNRP);
  • Membranoproliferative glomerulonephritis;
  • IgA nephropathy;
  • Alport’s syndrome;
  • Fabry disease.

It is important to remember that although these types of glomerulonephritis have primary causes, they can also be caused by other conditions , becoming secondary.

Secondary

Secondary glomerulonephritis is caused by other diseases that end up affecting the glomeruli and kidneys in some way, such as diabetes , which can cause kidney problems.

We will talk a little about each of the diseases that can cause glomerulonephritis in the topic “causes”.

Acute glomerulonephritis

Acute and chronic glomerulonephritis are, in principle, the same disease. The difference is in its duration and frequency. An acute glomerulonephritis is usually caused by infections, but can progress to chronic versions.

Acute usually lasts only a few days and is an isolated case, in addition to being common in children between 2 and 10 years of age.

Chronic glomerulonephritis

In chronic glomerulonephritis the condition remains for a longer time, and can last from a few weeks to a lifetime, or be frequent, appearing several times over the course of a few months.

This case is a little more serious and more prone to complications, since its effects persist for a long time before they are felt. It is common for this type of disease to be genetic.

Nephrotic syndrome and nephritic syndrome

Nephrotic and nephritic syndromes are two disorders of the glomeruli that can cause each other. This means that nephritic syndrome can cause nephrotic and vice versa. These are the main features:

Nephritic syndrome

In this case there is inflammation of the glomeruli, which classifies nephritic syndrome as a glomerulonephritis by definition and any type of nephritis can result in it. This inflammation reduces the filtration capacity of the kidneys. The result is that toxins are not properly eliminated from the body and can accumulate in the tissues.

Blood may appear in the urine, high blood pressure and acute renal failure.

Nephrotic syndrome

When nephrotic syndrome exists, inflammation is not always evident, but the filtration membrane malfunctions and may be damaged.

The result is that, unlike the case of nephritic syndrome, too much material goes through filtration. Proteins that are not supposed to pass through the filtration wall pass and end up in the urine. This condition is not a nephritis , but it can be caused by one, resulting in damage to the filtration walls.

It is also possible that the passage of materials that should not be filtered causes damage to the renal tubules and leads to inflammation in the glomeruli, creating a nephritic syndrome.

Causes

The causes for glomerulonephritis can be diverse and vary according to the type of the disease.

Acute diffuse glomerulonephritis

This type of glomerulonephritis is caused by an autoimmune reaction that appears a few weeks after an infection by streptococcal bacteria .

It affects all glomeruli, reducing their filtration capacity and causing problems, as the body cannot eliminate certain toxins, urea and creatinine .

He has nephritic syndrome.

Membranous glomerulonephritis

This glomerulonephritis causes inflammation and thickening of the basement membrane of blood capillary cells and renal glomeruli. Blood filtration continues to happen in a healthy way, but there is a loss of protein through the urine, characterizing nephrotic syndrome by nephritis.

It is common to be caused by infections with hepatitis B , hepatitis C and syphilis , as well as being frequent in people with a newly transplanted kidney or bone marrow. It can also be caused by systemic autoimmune diseases such as lupus , but in this case it would be secondary.

Glomerulonephritis due to minimal injuries

It is characterized by minimal or even absent changes when the glomeruli are examined under an optical microscope. Its extremely small changes, in most cases, can only be seen through the electron microscope, which is able to identify structures even smaller than the optical.

It is the most common type in children, representing 80% of nephrotic syndromes that affect people between 1 and 8 years of age. It can appear spontaneously, as well as due to Hodgkin’s lymphoma and the use of non-steroidal anti-inflammatory drugs.

Focal and segmental glomerulonephritis

This type of glomerulonephritis affects a small part of the glomeruli and it is often time consuming to be diagnosed because of this.

It happens after healing and hardening of a piece of the affected renal glomeruli. It is only after a long time that the symptoms begin to appear, since the loss of proteins is slow.

When primary, this condition is the result of genetic factors, but among the other causes are:

  • Drugs like heroin or anabolic steroids;
  • HIV;
  • Obesity;
  • Nephropathic reflux;
  • Sickle cell anemia.

Rapidly progressive glomerulonephritis

Often associated with lupus and Goodpasture’s disease, this condition is characterized by reducing the kidney’s filtering capacity by 50% over 3 months. It is the most aggressive type of glomerulonephritis , as the kidney can become unusable in just 6 months, making hemodialysis and transplantation necessary.

Membranoproliferative glomerulonephritis

This glomerulonephritis occurs when a lesion occurs in the basement membrane and in the mesangiums (cells that support the glomeruli). Some of the possible causes are:

  • Autoimmune diseases, such as lupus;
  • Cancer (leukemia or lymphoma);
  • Chronic infections (hepatitis B, C, malaria or endocarditis);
  • Kidney transplant rejection;
  • Paraprotein deposit disease.

IgA nephropathy

Also known as Berger’s disease , this kidney condition is caused by the deposition of immunoglobulin A in the glomeruli, causing inflammation and progressive damage to the structures. This disease has no cure, but there is treatment to prevent kidney failure.

The condition has genetic causes and it is common for it to be present in more than one person in the family. However, it can also be related to respiratory and intestinal infections, being a reaction of the immune system.

Alport syndrome

This is a genetic syndrome that affects, in addition to the renal system, hearing. It is caused by a genetic mutation in the sex X chromosome. The mutation hinders or prevents the production of collagen IV, which is used in the composition of basal cells.

These cells are thin structures that separate and support the cells. Without collagen IV, the basal cells of the kidney’s filtration membrane allow blood and proteins to pass.

Imperfect basal cells also cause hearing problems, since the capture of sound vibrations also depends on them.

As the mutation is present on the X chromosome, a man may have the condition, but he cannot pass it on to his sons, since the one who passes the X chromosome to the male descendants is always the woman.

The father can still pass the condition on to a female daughter, since when the child is female, an X chromosome came from each parent.

When Alport’s syndrome affects a man it is usually severe, causing severe kidney failure. However, most of the time it affects a woman, the only symptom is blood in the urine and there is no kidney failure. This is due to the fact that the woman has another X chromosome to do the job of the first.

There are cases, however, in which the woman may have severe renal failure, if both parents have the mutation and pass it on to the child.

Fabry disease

Also of genetic cause, Fabry’s disease is rare, hereditary and also affects the X chromosome. This disease causes deficiency or absence of the production of the lysosome Alpha-Galactosidase A. Thanks to the lack of this enzyme, accumulation of globotriaosilceramide, a type of fat, occurs , in many cells of the body. Among them, the renal ones.

The disease can cause blood vessel involvement and lead to death, as it affects several regions of the body, causing severe kidney damage over time, in addition to leading to myocardial infarction and stroke. The disease is rare, it is estimated to affect 1 in every 40 thousand live births.

Other causes

In addition to these types, the following diseases and conditions can cause secondary glomerulonephritis:

  • Diabetes;
  • Lupus;
  • Amyloidosis;
  • Goodpasture’s syndrome;
  • Polyarteritis nodosa;
  • Wegener’s granulomatosis;
  • Henoch-Schönlein purple;
  • Bacterial endocarditis.

Groups and risk factors

Anyone can develop glomerulonephritis, but some groups are at higher risk. Are they:

People with diabetes

Diabetes increases the chances of developing glomerulonephritis. This is because one of the possible consequences of diabetes is damage to small blood vessels. This affects several organs, including the kidneys, causing what is called diabetic nephropathy. Among the damaged vessels are those of the glomeruli, which causes glomerulonephritis and makes it difficult to filter the blood.

Arterial hypertension

Arterial hypertension is a curious case. It can cause and be caused by kidney problems. However, we will talk here about how it causes glomerulonephritis.

With higher blood pressure, the heart makes it harder to pump blood through the body and the arteries can be damaged. Both the large arteries and the small arterioles. It is these, which are part of the glomeruli, that cause glomerulonephritis secondary to arterial hypertension.

Frequent use of painkillers and anti-inflammatories

Analgesic and anti-inflammatory drugs, especially non-steroids, are filtered by the kidneys and cause damage to the glomeruli.

Carriers of autoimmune diseases

Autoimmune diseases, such as lupus, are conditions that cause a person’s immune system to attack healthy cells in the body.

Goodpasture’s syndrome, for example, causes rapid destruction of kidney cells and attacks the lungs. Polyarteritis nodosa causes an autoimmune reaction that leads to inflammation of small and medium-sized arteries.

Several other autoimmune diseases have the effect of damaging the glomeruli.

Amyloidosis carriers

Amyloidosis is a disease that causes protein to accumulate in the tissues of the body, including the kidneys, damaging the organs. It can be of genetic origin or in inflammation.

Symptoms

The vast majority of cases of acute glomerulonephritis do not even show symptoms. This is because the acute condition usually goes away before there is time for them to arise, and few glomeruli – out of a million of them – are affected. When symptoms appear, most of them do not cause major discomfort, but they are quite noticeable.

Chronic glomerulonephritis can take years to show signs, but eventually they will be noticed as the condition always comes back or never goes away. The result is that in these cases the symptoms arrive accentuated and renal failure can be present. The signs of the disease are:

Proteinuria

Proteinuria is the elimination of proteins through the urine. They do not normally pass through the glomeruli, but when there is glomerulonephritis (specifically in nephrotic syndrome), they are able to cross the barrier and appear in the urine. You can see that there is protein in the urine because it makes a lot of foam.

Hematuria

It is possible to perceive hematuria by the color of the urine, which turns pink or brown. Hematuria is the loss of blood through the urine and happens when blood cells can cross the glomerulus filtering membrane.

Edema

Due to filtration problems in the glomeruli, the blood may have an accumulation of electrolytes, which are essential for various functions of the body. This imbalance can cause edema.

They are swellings due to the accumulation of fluid and can happen on the feet, legs, abdomen and face. This is usually the first symptom to manifest and can be noticed on the face in the morning, for example.

Arterial hypertension

Due to problems with filtration or volume control (the blood volume, which is regulated by the kidneys), glomerulonephritis can cause high blood pressure.

Fatigue

The fatigue or tiredness , is a sign that the kidneys are not working well enough. It is one of the first signs of kidney failure, a possible complication of glomerulonephritis.

Warning signs

Rapidly progressive glomerulonephritis deserves special attention, as it is more dangerous than the others due to its rapid action. It progresses in a few months for all glomeruli, causing kidney failure and failure.

If your symptoms include fatigue , nausea , fever , abdominal pain  and joint pain , as well as itching and poor appetite , see a doctor. These symptoms can appear quickly and should be taken seriously.

How is the diagnosis made?

 

The diagnosis of glomerulonephritis is made by the nephrologist  (specialist responsible for the kidneys), based on some tests. Are they:

Urine analysis

The urine test seeks to find proteins, blood, glucose and other materials that may indicate problems in the functioning of the body. In the case of glomerulonephritis, signs of blood or protein are sought, which indicate the problem in the glomeruli.

Creatinine Clearance

Creatinine clearance is an exam that analyzes the filtration of blood based on the creatinine present in the urine. This material does not interfere with the functioning of the body, but it is a good indicator of how efficient the work of the kidneys is.

Blood test

Through the blood test it is possible to find out the concentration of toxins in the blood. This is a sign that the kidneys are not working properly and should be investigated.

Renal biopsy

During a kidney biopsy, a piece of the organ to be examined (in the case of the kidney) is removed and observed in the laboratory, under the microscope, looking for signs of damage. Through biopsy it is possible to identify damage and inflammation in microscopic structures, as is the case of glomeruli.

While urine and blood tests are excellent indicators of kidney problems, they are not as accurate for diagnosis as a biopsy, which can identify exactly where the problem is.

Is there a cure?

Yes , most of the time glomerulonephritis is curable. However, this depends on the cause, and treatment, in most cases, is very important to ensure a higher quality of life.

What is the treatment?

When glomerulonephritis is focal, that is, it affects a small amount of the glomeruli, treatment may not even be necessary. With few glomeruli affected, the consequences for the body are minimal and it can usually heal the injuries.

Likewise, cases of post-infectious glomerulonephritis usually resolve spontaneously.

However, sometimes it may be necessary to perform treatments. In this case, the options depend on the cause. In addition, one of the main focuses of treatment is to protect healthy glomeruli and ensure space and time for healing and regeneration of the damaged.

Treatment options include the following:

Anti-inflammatories and immunosuppressants

In cases where the condition occurs due to an autoimmune reaction, anti-inflammatory and immunosuppressive drugs are indicated. They serve to reduce the activity of the immune system that affects the glomeruli and their inflammation.

It is important to remember that the wrong use of anti-inflammatory drugs can worsen the condition of the kidneys.

Blood pressure control

When glomerulonephritis is caused by high blood pressure, its control is necessary so that there is no further damage to the glomeruli and for the lesions to be healed. For this, medicines can be used.

In addition, food is one of the main allies of those who want to reduce blood pressure. Sometimes just dietary rebalancing is enough to improve kidney health. It is necessary to reduce salt, fat and alcohol in the diet.

Diabetes control

When the patient has diabetes, it can be the cause of kidney damage. Control of the condition is extremely important through the necessary medications, medical monitoring and a severe reduction in the amount of sugar ingested in the diet.

Hemodialysis

Hemodialysis is the artificial filtration of blood. It is a treatment used when the kidneys are in a severe state of failure. Renal failure is a severe complication that may be due to glomerulonephritis.

Kidney transplantation

When the kidney is severely damaged by the condition, transplantation may be necessary. The cases in which this happens are rare, but when the kidney does not work, the transplant can be viable and, despite the risks of rejection, it solves, at first, the problem of glomerulonephritis.

The transplant is only necessary in specific cases when the kidneys arrive in a state of extreme insufficiency.

Medicines

Some medications can be used to control glomerulonephritis, especially when the condition has autoimmune causes. Are they:

  • Cyclophosphamide ;
  • Azathioprine ;
  • Cyclosporine ;
  • Corticoids ;
  • Mycophenolate mofetil .

Attention!

NEVER  self-medicate or stop using a medication without first consulting a doctor. Only he will be able to tell which medication, dosage and duration of treatment is the most suitable for his specific case. The information contained in this website is only intended to inform, not in any way intended to replace the guidance of a specialist or serve as a recommendation for any type of treatment. Always follow the instructions on the package insert and, if symptoms persist, seek medical or pharmaceutical advice.

Living together

Living with glomerulonephritis involves taking care of your kidneys, preventing them from suffering more, and reducing the number of toxins ingested.

Eat well

Avoiding and reducing sodium, fats, fatty meats, alcohol and proteins decreases the necessary work on the part of the kidneys. If there is kidney failure, decreasing the amount of these foods will reduce the amount of toxins that the kidneys need to filter out, thereby preventing dangerous build-ups in the body.

Drink less water

I know it sounds strange. The standard health recommendation is to drink more water, however, in cases of chronic kidney failure, drinking too much water will only put the kidney in greater stress , causing more damage and may lead to kidney failure over time.

The amount of water required per day can be indicated by the doctor after the creatinine clearance exam, but in principle, you should drink 600mL of water + the volume of urine daily.

In the case of a person who makes around 500mL of urine per day, you should drink 1100mL daily. The numbers may change according to the person’s diet and exercise routine – or lack of exercise – so it is recommended to receive the doctor’s recommendations .

Avoid sugar

Especially when the disease is caused by diabetes, avoiding sugar can help your kidney to recover, preventing it from suffering further damage.

Hemodialysis

When necessary, always come for hemodialysis. If your kidneys are not able to filter the blood by itself, the process is very important and missing it can cause serious health problems.

Prognosis

In most cases the diagnosis of acute glomerulonephritis is not dangerous and the condition can go away on its own. Even when she needs treatment, the tendency is for there to be complete cure with the right treatment.

Children have an easier time dealing with acute glomerulonephritis. Only 1% of cases progress to chronic kidney disease. In the case of adults, this happens to 10% of patients.

In cases where acute glomerulonephritis becomes chronic, healing is not so easy and medical monitoring is very important, especially if the condition progresses to renal failure, as hemodialysis may be necessary.

The prognosis also depends on the type of glomerulonephritis, the age of the patient and the time it takes for the diagnosis to be made.

For example, IgA nephropathy tends to develop slowly, taking up to 20 years to cause kidney failure. Rapidly progressive primary glomerulonephritis, on the other hand, can render a kidney useless in just 6 months, which is dangerous since the symptoms can be ignored or not appear for much of that time.

Complications

Glomerulonephritis has some complications. Are they:

Renal insufficiency

This is one of the main and most dangerous complications of glomerulonephritis.

With kidney failure, the kidney loses some of its ability to filter blood. If left untreated, the toxins that the organ should filter begin to accumulate in the body, leading to problems in other organs and even death, especially when the failure is severe or progresses to kidney failure .

Kidney damage can be quite problematic and, in addition to seeking a doctor, dietary care may be necessary to help treatment.

Fatigue is one of the first signs, which can also accompany poor appetite, trouble sleeping, nausea and itching.

Arterial hypertension

Just as blood pressure problems can cause glomerulonephritis, kidney disease can lead to high blood pressure.

The kidneys are responsible for several things in the body. Among them, blood volume, which is the control of blood volume in certain regions. With damaged blood volume, blood pressure can become uncontrolled in some parts of the blood system.

Anemia

Blood loss through urine, if prolonged and untreated, can cause anemia in the patient, who loses several blood cells.

How to prevent

Prevention of glomerulonephritis can be complicated as most causes are autoimmune. However, there are steps you can take to avoid the condition.

food

Eating properly reduces the chances of hypertension and diabetes and, by table, reduces the risks of developing glomerulonephritis. Therefore eating little sodium, fats and sugars is indicated to prevent the condition, as well as other diseases.

Medication control

Taking medications only when and as directed by the doctor is important. In the case of glomerulonephritis, anti-inflammatory drugs increase the risks, so you need to be careful with them.

Condom use

Among the causes of glomerulonephritis is syphilis and hepatitis. These diseases are sexually transmitted and can be prevented by using condoms during sex.

Avoid used syringes

Hepatitis can also be contracted using used syringes, as they can pass through the blood. Staying away from syringes that have been used by others who may have hepatitis is a way of ensuring that the disease is spread, reducing the chances of nephritis.

Treatment of infections

Many cases of glomerulonephritis begin after infections. Treating them properly, following the doctor’s instructions and taking antibiotics according to medical instructions  is very important to eliminate the infection.

After this type of treatment, it is recommended to watch carefully for any possible urinary changes.

Do not smoke

Smoking also increases the chances of hypertension, in addition to being a major risk to the health of the entire body. Quitting smoking is very important to ensure a higher quality of life and a healthier life as a whole.


Glomerulonephritis is a disease that usually passes by itself, but if left untreated when necessary it can cause serious problems for the patient.

Remember to show this text to your friends, they may be interested in learning more about their own kidneys!

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