Chronic Glomerulonephritis

Chronic glomerulonephritis is a slowly progressive disease characterized by inflammation of the glomeruli, which results in sclerosis, scarring and, eventually, renal failure. This condition normally remains subclinical until the progressive phase begins. By the time it produces symptoms, chronic glomerulonephritis is usually irreversible.

Causes

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 hypertension and chronic renal 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.

Signs and Symptoms

• Blood in the urine (dark, rust-colored, or brown urine)
• Foamy urine

• Unintentional weight loss
• Nausea, vomiting
• General ill feeling (malaise)
• Fatigue
• Headache
• Frequent hiccups
• Generalized itching
• Decreased urine output
• Need to urinate at night
• Easy bruising or bleeding

Diagnostic tests

The following findings support a diagnosis of chronic glomerulonephritis:

• Urinalysis shows proteinuria, hematuria, cylindruria, and red blood cell casts.
• Blood studies reveal rising blood urea nitrogen and serum creatinine levels in advanced renal insufficiency as well as a decrease in hemoglobin.
• X-rays exhibit symmetrically contracted kidneys with normal pelves and calyces.
• Renal biopsy establishes the underlying disease and provides data to plan therapy.

Treatment

Appropriate treatment is essentially nonspecific and symptomatic. Goals include controlling hypertension with antihypertensives and a sodium-restricted diet, correcting fluid and electrolyte imbalances through restrictions and replacement, reducing edema with loop diuretics such as furosemide, and preventing heart failure. Treatment also may include antibiotics for symptomatic urinary tract infections (UTls), dialysis, or kidney transplantation.

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.