There are some instances where a renal dysfunction is caused as a result of administration of drugs or agents for some other totally unrelated medical condition. Glomerulonephritis or Glomerular Nephritis is an inflammatory disease of glomeruli and small blood vessels. Early treatment prevents End Stage Renal Disease and serious complications.1 In this article we will discuss causes, symptoms and treatment of Glomerulonephritis.

Glomerulonephritis or Glomerular Nephritis

Causes of Glomerulonephritis or Glomerular Nephritis

Glomerulonephritis or Glomerular Nephritis Due to Infections

  • Bacterial Infection- Follows streptococcal infection or skin infection.
  • Viral Infection- HIV, hepatitis viral infection and viral vascular infection followed with glomerulonephritis.

Glomerulonephritis or Glomerular Nephritis Due to Auto-Immune Diseases

  • IgA nephropathy
  • Goodpasture's syndrome
  • Lupus erythematosus

Glomerulonephritis or Glomerular Nephritis Due to Vascular Inflammatory Disease

  • Polyarteritis
  • Wegener's granulomatosis

Glomerulonephritis or Glomerular Nephritis Due to Chronic Diseases

  • Hypertension
  • Diabetes2

Describe Changes In Kidney Caused By Glomerulonephritis or Glomerular Nephritis?

  • The microscopic lesions suggest heterogeneity of segmental lesions.3
  • Glomerulonephritis is an inflammatory disease caused by immune mediated injury.
  • Immune response is triggered by antigen resulting in infiltration of kidney tissue by macrophages and lymphocytes and crescent formation. Inflammation of glomeruli and smaller renal blood vessels are triggered by immune deposits and compliment activation.
  • Published scientific studies suggest inflammation of glomeruli and arterioles is triggered by Anti-Tumor Necrosis Factor Alfa.

What Is Tumor Necrosis Factor Alpha?

  • Tumor Necrosis Factor (TNF) Alfa is also known as Tumor Necrotic Factor. TNF alpha is an endogenous protein and pyrogens causing inflammation and fever.
  • Secretion of TNF by immune cells is regulated by immune response.
  • TNF is elevated in several other non-inflammatory diseases like Alzheimer disease, cancer and major depression.
  • TNF alpha is also associated with Rheumatoid Arthritis, Juvenile Rheumatoid Arthritis and ankylosing spondylitis.

Anti-Tumor Necrosis Factor Alpha Therapy Causing Glomerulonephritis or Glomerular Nephritis?

  • Inflammatory diseases caused by TNF alpha are treated with anti TNF medications.
  • Research and scientific papers published suggest anti TNF alpha therapy causes glomerular disease in some Rheumatoid Arthritis patients.
  • The biopsy and kidney function test of patient treated with anti-TNF alpha medications suggest renal dysfunction.
  • Test result indicates numerous pathologic findings in the renal system to include proliferative lupus glomerulonephritis, crescent glomerulonephritis, and membranous glomerulonephritis along with renal vasculitis.
  • The role of anti-TNFα agents as an etiology for renal dysfunction is supported by following observations:
    • The connection between glomerular diseases to medication use in people with longstanding history of Rheumatoid Arthritis with no previous history of renal dysfunction.
    • The improvement of symptoms that the individual experiences and improvement in lab abnormalities with tapering and gradual discontinuation of anti-TNFα agents along with adding immunosuppressive agents
    • One such agent is the Anti-Tumor Necrosis Factor Alpha drug usually used for treatment of Rheumatoid Arthritis but it has shown to cause renal dysfunction in the form of Glomerulonephritis.

Symptoms of Glomerulonephritis or Glomerular Nephritis

Non-Specific Symptoms of Glomerulonephritis or Glomerular Nephritis

  • Generalized Weakness and malaise
  • Fatigue
  • Fever
  • Nausea
  • Muscle Pain

Specific Symptoms of Glomerulonephritis or Glomerular Nephritis

  • Pain- Abdominal or flank pain
  • Retention of Fluid- Causing edema feet, swelling of face and pleural effusion
  • Cardiovascular Abnormalities- Hypertension and arrhythmia.
  • Urine Abnormalities- Increased urination or retention and urine discoloration orange to red urine because of hematuria.

Diagnosis for Glomerulonephritis or Glomerular Nephritis

Symptoms of Glomerulonephritis develop gradually and over a period of time. The diagnostic tests are advised following finding of abnormal symptoms during routine examination. Most common test advised is urine examination and blood electrolyte study. These studies are followed by special blood test of kidney and radiological studies.

Following Are The Laboratory Tests To Confirm The Diagnosis of Glomerulonephritis or Glomerular Nephritis:

Urine Examination for Glomerulonephritis or Glomerular Nephritis

Abnormal findings are observed in patient suffering with glomerulonephritis are as follows-

  • Abnormal Creatinine Clearance
  • Hematuria
  • Proteinuria
  • Estimate Excretion of Urine Total Protein
  • Uric Acid in Urine
  • Urine Concentration Test
  • Abnormal Specific Gravity of urine

Blood Examination for Glomerulonephritis or Glomerular Nephritis

The following blood tests are abnormal in case of Glomerulonephritis:

  • Low Hemoglobin
  • Increased BUN and Creatinine
  • Positive Anti-Glomerular Basement Membrane Antibody Tests
  • Positive Antineutrophil Cytoplasmic Antibodies
  • Antinuclear Antibodies is increased.
  • Complement Levels are increased.
  • Anti-Neutrophil Cytoplasmic Antibody (ANCA) Blood Test is increased.
  • Tests to look for specific infections such as hepatitis B or hepatitis C

Radiological Studies to Diagnose Glomerulonephritis or Glomerular Nephritis

Some of the radiological studies that may be done to confirm the diagnosis of Glomerulonephritis are:

  • CT scan of the kidney and abdomen
  • MRI of the kidney and abdomen
  • Intravenous pyelogram

Kidney Ultrasound for Glomerulonephritis or Glomerular Nephritis

  • Ultrasound study is performed to examine the kidneys shape and external surface.

Kidney Biopsy for Glomerulonephritis or Glomerular Nephritis

  • Kidney Biopsy- If glomerulonephritis is suspected, a procedure to remove a small sample of kidney tissue may be recommended. This is called a biopsy.
  • Procedure- A kidney biopsy is usually carried out using local anesthetic to numb the area. An ultrasound machine will be used to locate your kidneys and a small needle will be used to take a sample. The test carries a small risk of bleeding so you will need to remain in hospital for a while on the day of the procedure, or sometimes overnight.
  • Microscopic Examination- The tissue sample will then be examined under a microscope in a laboratory to confirm a diagnosis of glomerulonephritis, find out how serious the condition is, and determine the most appropriate course of treatment. Read more about treating glomerulonephritis.

Treatment for Glomerulonephritis or Glomerular Nephritis

Conservative Treatment for Glomerulonephritis or Glomerular Nephritis

Dietary Changes for Glomerulonephritis or Glomerular Nephritis

  • Reduced amount of salt intake
  • Reduced potassium intake- Avoid food and drinks containing high amount of potassium.
  • Reduce fluid intake
  • Choose low protein diet

Alcohol and Smoking-

  • Discontinue alcohol and smoking

Medications4 for Glomerulonephritis or Glomerular Nephritis

  • Pain- Treat pain with NSAIDs as needed or opioid for regular continuous pain
  • Autoimmune Disease- Suppression of immune response prevents further
  • Kidney damage.
    • Corticosteroids- Most common corticosteroid prescribed is prednisolone.
    • Cytotoxic Drugs- Cyclophosphamide has been used to suppress autoimmune reaction.
    • Azathioprine
    • Cyclosporine
  • Viral Infection-
    • Antiviral medications are prescribed in acute cases.
  • Hypertension
    • Treated with anti-hypertensive medications
    • Most common anti-hypertensive medication used is ACE inhibitors.
    • Alternatively vasodilator drugs are used to treat hypertension. Vasodilator most often used is nitroprusside and nifedipine.
  • Hypercholesterolemia- Medications are prescribed to reduce cholesteroid levels.
  • Antiarrhythmic Medications- Increased potassium level causes arrhythmia, which is treated with anti-arrhythmic medications.
  • Diuretics- Water retention is treated with diuretics.

Surgical Procedures for Glomerulonephritis or Glomerular Nephritis

Plasma Exchange5 Procedure for Glomerulonephritis or Glomerular Nephritis

  • Removal of plasma helps to eliminate antibodies triggering autoimmune reaction resulting in glomerulonephritis.
  • Blood is removed using intravenous catheter and passed through a machine. Plasma is separated from blood cells and removed.
  • Plasma substitute is added to blood followed by transfusion of the plasma substitute blood in to patient's vein.

Kidney Transplant Procedure for Glomerulonephritis or Glomerular Nephritis

  • Healthy donor donates kidney, which is very closely matched with patient's immune system.

Kidney Dialysis Procedure for Glomerulonephritis or Glomerular Nephritis

  • Peritoneal or blood dialysis is performed twice or thrice a week.

References

1. Rapidly progressive crescentic glomerulonephritis: Early treatment is a must.
Moroni G1, Ponticelli C2.
Autoimmun Rev. 2014 Jul;13(7):723-729.

2. An evaluation of diabetic and pseudodiabetic glomerulosclerosis.
Herf S, Pohl SL, Sturgill B, Bolton WK.
Am J Med. 1979 Jun;66(6):1040-5.

3. Histological heterogeneity of glomerular segmental lesions in focal segmental glomerulosclerosis.
Taneda S1, Honda K, Uchida K, Nitta K, Yumura W, Oda H, Nagata M.
Int Urol Nephrol. 2012 Feb;44(1):183-96.

4. Current and emerging treatments for idiopathic focal and segmental glomerulosclerosis in adults.
Ponticelli C1,
Graziani G.Expert Rev Clin Immunol. 2013

5. Plasmapheresis for the prophylaxis and treatment of recurrent focal segmental glomerulosclerosis following renal transplant.
Valdivia P1, Gonzalez Roncero F, Gentil MA, Jiménez F, Algarra G, Pereira P, Rivera M, Suñer M, Cabello V, Toro J, Mateos J.
Mar;9(3):251-61. Transplant Proc. 2005 Apr;37(3):1473-4.

Written, Edited or Reviewed By:

, MD, FFARCSI

Last Modified On: May 6, 2014

Pain Assist Inc.

Pramod Kerkar
  Note: Information provided is not a substitute for physician, hospital or any form of medical care. Examination and Investigation is necessary for correct diagnosis.

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