Definition

Glomerulonephritis is a kidney disease caused by inflammation of the glomerulus tissue in the kidney. The glomerulus is a structure inside the kidney responsible for filtering blood and removing excess fluid and waste substances, which are then expelled as urine. Glomeruli are located inside the kidney and cannot be seen with the naked eye.

Glomerulonephritis can happen suddenly (acute) or gradually and long-lasting (chronic). Acute glomerulonephritis is marked by sudden onset and worsening symptoms rapidly. Inflammation in the glomeruli can occur spontaneously or as a side effect of another disease.

Meanwhile, prolonged inflammation in the glomeruli will lead to kidney damage. Immediate management of acute glomerulonephritis should be done to avoid serious complications in the future.

Causes

The are several causes of acute glomerulonephritis. Inflammation occurring in the glomerular tissue can be caused by various factors, such as other medical conditions or disorders of the kidneys themselves. Some of the most common causes of acute glomerulonephritis are:

1. Infections

The most common infection that can cause acute glomerulonephritis is a history of Streptococcus bacterial infection. Infections that can lead to this condition include upper respiratory tract infections and skin infections. Infection of the heart valves (endocarditis) can also cause this disease. Glomerulonephritis typically occurs 1-3 weeks after the acute bacterial infection. Other microorganisms that can cause infection include:

• Hepatitis B virus
• Hepatitis C virus
• HIV
• Staphylococcus bacteria, etc.

2. Autoimmune diseases

Autoimmune diseases occur when the body's immune system attacks healthy tissues. Examples of autoimmune diseases include:

• Systemic lupus erythematosus (SLE), the most common type of lupus causes inflammation and widespread tissue damage
• Goodpasture's syndrome, where the body's immune system attacks the lungs and kidneys
• IgA nephropathy or Berger's disease, a kidney disorder characterized by the accumulation of IgA antibodies in the kidneys

3. Vasculitis

Vasculitis is inflammation of blood vessels. Examples of diseases that can cause acute glomerulonephritis include polyarteritis, which affects medium-sized blood vessels that supply blood to the skin, nervous system, joints, kidneys, digestive tract, etc.

4. Sclerotic conditions

These conditions occur when other diseases cause damage to the glomeruli, leading to a decline in kidney function. Some of these conditions include:

• High blood pressure
• Diabetic nephropathy or kidney damage due to diabetes mellitus
• Glomerulosclerosis, scarring of the glomeruli in the kidneys

Risk factor

Acute glomerulonephritis can occur at any age but is more commonly experienced by children. Typically, the acute condition of this disease affects children aged 5 to 15 years old, although it can occur in individuals of any age. The risk of the disease increases if there has been a previous infection related to Streptococcus bacteria, such as a sore throat or skin infection.

Symptoms

The symptoms of acute glomerulonephritis develop rapidly, unlike the gradual and long-term onset of the chronic condition. These symptoms can manifest approximately three weeks after a previous infection. Common symptoms of acute glomerulonephritis include:

• Pink or brownish urine, indicative of blood in the urine (hematuria).
• Foamy urine resembling dishwashing foam caused by excess protein in the urine (proteinuria).
• High blood pressure (hypertension).
• Fluid retention, characterized by swelling in the face, hands, feet, and abdomen (edema).
• Reduced urine output or urinating less frequently than usual.

Additional nonspecific symptoms that may accompany acute glomerulonephritis include:

• Nausea and vomiting.
• Headaches.
• Muscle cramps.
• Fatigue.
• Shortness of breath due to fluid buildup in the lungs.
• Decreased appetite.
• Dry and itchy skin.

Diagnosis

The diagnosis of acute glomerulonephritis begins with a medical interview followed by physical examinations. During the physical examination, signs such as high blood pressure, facial swelling, and changes in urine may be observed. The doctor will also assess for signs of fluid overload and signs of infection.

Acute glomerulonephritis can sometimes be detected suddenly through urine tests, even without specific symptoms from the patient. Therefore, the doctor may conduct additional tests to confirm the diagnosis, including:

• Urinalysis: This test examines urine over a 24-hour period to detect the presence of blood, protein, and other urinary components.
• Blood tests: Blood tests assess urea, creatinine, electrolyte levels, and the activity of the complement system, providing insight into kidney function and immune system activity.
• Radiological examinations: In some cases, chest X-rays, kidney ultrasound, and CT scans may be necessary to assess the shape and condition of the kidneys.
• Kidney biopsy: Although rare, a kidney biopsy may be performed to obtain a detailed examination of kidney tissue under a microscope. This procedure can help determine the severity of damage to the glomeruli

Management

Acute glomerulonephritis management is usually supportive. If acute glomeruphritis occurs due to other diseases, what needs to be addressed first is the underlying disease. This happens because there is no specific treatment that can be done. The goal of glomerulophritis therapy is to prevent further damage to kidney function. Even in some cases, glomerulophritis can heal itself. Governance will be given by doctors to reduce disease severity and deal with the symptoms experienced.

Some of the drugs doctors can give for acute glomerulonefritis are:

• Antibiotics to prevent the spread of bacterial infection in the body, although antibiotics will not prevent the occurrence of glomerulonephritis.
• Diuretics is a drug that is useful for increasing the production of body fluids, so symptoms of body swelling and increased blood pressure can improve.
• Blood pressure reduction drugs.
• Corticosteroids are used when acute glomeruophritis occurs due to autoimmune disease. This drug can reduce inflammation in the kidneys.
• Vasodillator or drug that widens blood vessels, is used for cases of severe hypertension or if there is any suspicion of damage to the brain (encephalopathy).

Doctors will ask you to reduce salt and liquid consumption, especially if the disease is in an acute or recent phase, to control symptoms of swelling and hypertension. Blood pressure checks will be carried out routinely, as well as monitoring the urine issued for 24 hours. You will be asked to take a total break (bed rest) or being hospitalized until symptoms of inflammation decrease.

If you have experienced kidney failure, the doctor will recommend dialysis therapy or analyzed. This procedure uses a machine that is used as a substitute for the kidneys and filters blood in the body. If the case is severe enough and the therapy is analyzed, doctors can perform kidney transplant surgery.

Complications

The complications that can occur due to glomerulonephritis vary and depend on the treatment that has been carried out. The most severe implication of this disease is the death that occurs a lot in pediatric patients. Acute Glomerulonophritis can also cause disturbances in other organs of the body as a result of the buildup of metabolic waste in the blood, high blood pressure, loss of red blood cells and proteins that come out with urine.

Some of those complications are:

• Acute kidney failure, which is the worsening of the kidney function that occurs suddenly in a short time. If it is heavy, it can require dialysis.
• Clinical kidney failure, a condition that can develop into kidney death in a short time. Kidneys that are no longer able to work properly will require dialysis or kidney transplantation.
• Hypertension or increased blood pressure due to damage to severe gglomerulus.
• Electrolytes imbalance in the blood.
• A long-lasting urine disorder.
• Retinopathy hypertension, increased blood pressure that causes eye problems.

Prevention

There is no specific prevention from acute glomerulonefritis. Even so, some things can be considered further as a form of prevention are:

• Immediately seek treatment if you have a streptokocus bacterial infection such as a sore throat or skin infection.
• If you are sexually active, practice safe sexual intercourse to prevent urinary tract infection.
• Control the blood pressure.
• Controls blood sugar.
• Quit smoking.
• Keeping an ideal weight.

When to see a doctor?    

Seek medical attention promptly if you experience the above symptoms. Regular health check-ups are recommended because conditions can develop before specific symptoms appear. Seek comprehensive treatment if you've previously had bacterial or viral infections. Consult a doctor immediately if your child experiences high fever, changes in urine, or sudden body swelling.

Looking for more information about other diseases? Click here!