Definition The filtering structures of the kidneys are called the glomeruli. Injury to these can cause protein and blood cells to leak into the urine and can impair kidney function. The condition is called primary glomerulonephritis (GN).
What is going on in the body? Primary glomerulonephritis stems from damage to the glomeruli. Most often this is the result of inflammation of the tissue. The injury can be mild with few symptoms. It can also be severe and life threatening. There are three structures within the glomeruli that can be affected. They are:
connective tissue called the mesangium
tiny blood vessels called capillaries
membranes surrounding the blood vessels
There are six major syndromes associated with primary GN. They include:
acute glomerulonephritis
rapidly progressive glomerulonephritis
chronic glomerulonephritis
nephrotic syndrome
blood in the urine, called haematuria
protein in the urine, called proteinuria
What are the signs and symptoms of the disease? Symptoms of the disease include:
swelling and fluid retention
blood in the urine
high blood pressure
shortness of breath
decreased or increased urine output
Primary GN can also cause uraemia. This is a high level of waste products, such as a substance called urea that is normally filtered into the urine, from the blood. It is a sign of kidney failure. Symptoms of uraemia include:
nausea and vomiting
fatigue
hiccups
changes in mental status
What are the causes and risks of the disease? Several things can contribute to the risk for primary GN. These include:
genetic tendencies
autoimmune disorders, such as a condition called systemic lupus erythematosus, in which a person's immune system attacks his or her own body for unknown reasons
infections
chronic viral hepatitis, an infection of the liver
What can be done to prevent the disease? Treatment of the underlying disease or infection may prevent this condition.
How is the disease diagnosed? Diagnosis is based on several factors. These include:
medical history
physical examination
data from laboratory tests
examination of the urine
Blood tests useful in making the diagnosis include:
antibody tests that may detect an autoimmune condition
antibody tests that may detect an infection such as chronic hepatitis
protein tests that may detect a cancer
protein tests that may detect inflammation of the kidney
A renal biopsy, which involves using a special needle to obtain a piece of tissue from the kidney so that it can be examined under a microscope, may be needed to confirm the diagnosis. It is also useful in choosing treatment.
What are the treatments for the disease? Treatments for primary GN include:
antihypertensives or high blood pressure medications
diuretics or water pills
ACE inhibitors, such as enalapril, lisinopril, or captopril
antibiotics for infection
chemotherapy for cancer related causes
dietary restrictions
corticosteroids, such as prednisone or dexamethasone
immunosuppressives
cytotoxic agents
haemodialysis, or hooking the person up to a machine that filters the blood
What are the side effects of the treatments? Taking corticosteroid drugs over a long period can weaken the bones. Immunosuppressive and cytotoxic therapies can increase a person's risk of infections and cancer. Other side effects depend on the treatment given.
What happens after treatment for the disease? Expectations for recovery vary according to the type and extent of the disease.
How is the disease monitored? People with this condition should be under the care of a doctor specialising in kidney diseases, known as a nephrologist. Blood pressure, spillage of protein into the urine, and kidney function need to be measured regularly.
Author: Crystal R. Martin, MD Reviewer: HealthAnswers Australia Medical Review Panel Editor: Dr David Taylor, Chief Medical Officer HealthAnswers Australia Last Updated: 1/10/2001 Contributors Potential conflict of interest information for reviewers available on request
