- Glomerulonephritis: description
- Glomerulonephritis: symptoms
- Glomerulonephritis: causes and risk factors
- Glomerulonephritis: examinations and diagnosis
- Glomerulonephritis: treatment
- Glomerulonephritis: disease course and prognosis
The term glomerulonephritis includes a number of inflammations affecting the kidneys. What they all have in common is that the kidney body (Malpighi body) is affected. In glomerulonephritis, both kidneys are typically affected. Glomerulonephritis is triggered by immune system defenses and, if left untreated, can trigger kidney failure (renal insufficiency). Find out more about the disease here.
ICD codes for this disease: ICD codes are internationally valid medical diagnosis codes. They are found e.g. in doctor's letters or on incapacity certificates. N03N00N01N05N02
Causes and risk factors
Examinations and diagnosis
Disease course and prognosis
Glomerulonephritis is not a single disease but includes a number of inflammatory diseases affecting the kidneys. It is characteristic of a glomerulonephritis that it affects both kidneys. In addition, unlike the inflammation of the renal pelvis (pyelonephritis), which is caused by bacteria, it is immune-mediated, ie an autoimmune disease. That is, the body's immune system triggers the inflammation. All disorders that include the term glomerulonephritis have in common that they affect the renal corpuscles.
The renal corpuscles (Malpighi corpuscles) are part of the nephron, a subunit of the kidney. It is a filtration unit of which each kidney has around one million pieces. The kidney bodies filter and remove the waste products from the blood. In this way, they form the urine, which enters the bladder via the ureters and is then excreted through the urethra. The renal corpuscles consist of a vascular bundle, the so-called glomerulus. A disorder affecting the renal corpuscles is called glomerulopathy. If the kidney corpuscles are affected by inflammation, there is talk in the medicine of a glomerulonephritis. It usually affects both kidneys. As a result of glomerulonephritis, the filtering function of the kidneys is impaired.
A glomerulonephritis is immune-mediated - that is, the body's own immune system (immune system) triggers the inflammation, not pathogens such as bacteria. Certain immune system defenses cause inflammation of the glomeruli. There is no uniform classification of glomerulonephritis, but one can distinguish between primary glomerulonephritis and secondary glomerulonephritis by their causes.
A primary glomerulonephritis is present if the inflammation of the kidneys or the kidney corpuscles is not due to an existing underlying disease. However, if the renal corpuscles are ignited due to a disease outside the kidney, there is talk of a secondary glomerulonephritis.
Depending on the cause, the course and the symptoms as well as the treatment of a glomerulonephritis differ. It can be acute (acute glomerulonephritis) and progress rapidly (so-called rapid progressive glomerulonephritis), leading to long-lasting, chronic glomerulonephritis. Some forms of these inflammations can be severe and lead to kidney failure (renal insufficiency).
For more on the signs and symptoms of glomerulonephritis, see Glomerulonephritis Symptoms.
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Glomerulonephritis: causes and risk factors
The different forms of glomerulonephritis have different causes. The inflammations, however, go back to a reaction of the body's defense of the immune system. It is also called an immune-mediated disease. The immune system forms antibodies against invading, foreign substances. They recognize certain structures (so-called antigens) on the foreign substances and form complexes, the antigen-antibody complexes.
The antibodies or complexes can be deposited in the renal bodies and thus lead to inflammation. But it is also possible that the immune system forms antibodies (so-called autoantibodies), which falsely attack the body's own tissue and thereby trigger glomerulonephritis. These cases are rare.
If the causes of the inflammation do not go back to an existing underlying disease, there is a primary glomerulonephritis. Most of the triggering causes of these forms of the disease are unknown. An example of this is the so-called IgA nephritis, also called Berger's disease. It is the most common form of primary glomerulonephritis.
In IgA nephritis, the antibody IgA deposits in the tissue of the kidney cells and cause the inflammation, whereby the filter function is disturbed: The filter cells can no longer retain blood proteins and red blood cells (erythrocytes). They are excreted in the urine. In contrast, toxic metabolic products remain in the body and cause further damage there. The reasons why the antibodies are deposited in the tissue of the renal corpuscles are unknown.
Glomerulonephritis can also develop as a result of infection (so-called post-infectious glomerulonephritis). Often, the antibodies produced against the pathogens form complexes with the pathogens and deposit in the renal corpuscles. An example of a pathogen is streptococci (poststreptococcal glomerulonephritis).
Secondary glomerulonephritis is when the inflammation of the kidneys is due to disease. Causes of secondary glomerulonephritis include:
- Certain connective tissue diseases (autoimmune diseases), e.g. systemic lupus erythematosus (SLE)
- Inflammations of the endocardium (endocarditis lenta)
- Hepatitis (liver inflammation)
- Genetic defects
Glomerulonephritis: examinations and diagnosis
Glomerulonephritis often has no noticeable symptoms and is therefore often discovered in other studies. At the beginning of the examination, the doctor raises the medical history (anamnesis). Among other things, he asks the following questions:
- Were there any previous (bacterial) infections?
- Are there certain underlying diseases?
- Do you take any medicine?
- Do symptoms occur? If yes, which?
- Do you suffer from high blood pressure?
This is followed by a thorough physical examination, during which the doctor palpates and taps the kidneys, making sure that the lateral construction regions (flanks) and the area between the last rib and the spinal column hurts. He also measures the blood pressure and examines for fluid retention in the tissue (edema).
For further diagnosis of glomerulonephritis, blood and urine tests are performed. The urine is examined mainly for protein, because a glomerulonephritis is characterized by an increased protein excretion with the urine (proteinuria). For urine testing, urine is usually collected for 24 hours and then examined in the laboratory. In addition, the doctor checks the urine for blood, which is often excreted in a glomerulonephritis with the urine (so-called hematuria) and is usually already visible by a reddish color of the urine with the naked eye.
Another component of the diagnosis of glomerulonephritis is a blood test. Here, especially the so-called creatinine value of interest. Creatinine is a metabolite and is excreted in the urine via the kidneys. An elevated creatinine level indicates impaired renal function, which may be the result of glomerulonephritis. In addition, antibodies can be detected in the blood that are indicative of a recent infection.
For diagnosis, imaging techniques can also be used. In the diagnosis of glomerulonephritis, ultrasound examination (ultrasound) is of particular importance. Using ultrasound, the doctor can assess the condition of the kidney based on size, shape and location.
In order to clarify which form of glomerulonephritis is involved, the doctor takes a tissue sample from the kidney (biopsy) in a surgical procedure. This is examined under the microscope in order to be able to make a precise statement about the cause of glomerulonephritis. This study forms the basis for the therapy and the prognosis.
The therapy of a glomerulonephritis depends on both the cause and the course, so whether it is an acute glomerulonephritis or already is a chronic glomerulonephritis. If urinary protein excretion is low, if there are very few red blood cells in the urine, and if kidney function and blood pressure are normal, glomerulonephritis sometimes can not be treated. Nevertheless, you should have your doctor check you regularly.
Secondary glomerulonephritis treats the underlying condition that triggers the inflammation. An acute postinfectious glomerulonephritis resulting from a bacterial infection, for example by streptococci (poststreptococcal glomerulonephritis) is treated with antibiotics.
Acute glomerulonephritis should be treated as quickly as possible to prevent its development into chronic glomerulonephritis and permanent damage to the kidneys. Since in patients with glomerulonephritis the blood pressure is often elevated, it has to be normalized with antihypertensive medications (for example so-called ACE inhibitors). Increased blood pressure not only damages the kidneys, but also increases the risk of certain cardiovascular diseases such as stroke or heart attack. The goal of the treatment is a blood pressure between 125/75 and 130/80 mmHg. Fluid accumulations in tissues (edema), which are caused by a glomerulonephritis, are treated with dehydrating drugs, so-called diuretics.
Since glomerulonephritis is often caused by an overreaction of the immune system, so-called immunosuppressive therapy is necessary, for example with cortisone: It slows down the immune system and thereby prevents the disease from progressing.
As a result of inflammation, the filtering function of the kidneys is limited. Therefore, as part of the treatment and the diet must be adjusted. These include a low-protein and low-salt diet and adequate hydration.
However, if a glomerulonephritis is already well advanced and the kidneys fail (renal insufficiency), a blood wash (dialysis) or - as a last resort option - a kidney transplantation is often necessary.
Glomerulonephritis is not caused by bacteria or other pathogens. It is immune mediated, that means the own immune defense leads to the inflammations. Therefore, there is no specific measure to prevent glomerulonephritis. It is therefore important to have regular check-ups with the doctor. He can detect signs of illness with the help of blood and urine tests in the laboratory. Thus, a glomerulonephritis can be recognized in good time and above all be treated early, before it comes to a serious course.
Read more about the investigations
Glomerulonephritis: disease course and prognosis
The course of a glomerulonephritis may be acute or chronic. It is therefore important that inflammation is detected and treated early enough so that it does not become chronic. Untreated glomerulonephritis is one of the most common causes of complete kidney failure (renal failure) and inflammation of the kidneys increases the risk of cardiovascular disease. The problem is that many forms of glomerulonephritis cause only minor discomfort and are therefore not recognized at first. However, the prognosis is good and the disease does not lead to permanent damage to the kidneys.
A particular form of acute glomerulonephritis is rapid progressive glomerulonephritis (RPGN). This is an inflammation that progresses particularly quickly: If left untreated, the kidney filter function can decrease by 50 percent within three months, and the kidneys can completely fail within six months. A particularly rapid treatment is therefore imperative in this glomerulonephritis - the sooner, the better the healing prospects.
The disease is often without symptoms for a long time and goes unnoticed, often for years. The result: Renal damage progresses. A chronic glomerulonephritis is no longer curable and in many cases ultimately leads to a failure of the kidneys. A dialysis or kidney transplant is the last treatment option.
Read more about the therapies
These laboratory values are important