Definition

Glomerulonephritis is an inflammation that occurs in the glomeruli, structures inside the kidneys formed from a collection of small blood vessels. The network of blood vessels in the kidneys filters blood from metabolic waste and removes excess fluid from the body. Eventually, all these fluids and waste products are excreted as urine. If the glomeruli are damaged, it can disrupt kidney function, and if left untreated, it can lead to kidney failure.

Chronic glomerulonephritis is a form of inflammation in the glomerular structure that occurs over years, usually following nearly all cases of acute glomerulonephritis. In acute glomerulonephritis, glomerular inflammation occurs suddenly and lasts only briefly. If left untreated, the damage to the glomeruli cannot be repaired, leading to chronic kidney disease, end-stage renal failure, and cardiovascular disease. Approximately 1% of children and 10% of adults with acute glomerulonephritis may see their condition progress into chronic glomerulonephritis.

Chronic glomerulonephritis is the third leading cause of chronic kidney failure and is found in about 10% of patients requiring dialysis. The exact cause of chronic kidney failure in patients with glomerulonephritis is not known in some cases. According to data from Japan and other Asian countries, chronic glomerulonephritis occurs in 40% of patients undergoing dialysis.

Causes

The causes of glomerulonephritis can stem from kidney damage or result from various other diseases. These conditions can also affect other parts of the body before eventually impacting kidney function. Generally, the causes of chronic glomerulonephritis are similar to those of acute glomerulonephritis. However, untreated kidney inflammation in acute glomerulonephritis can progress over years, leading to chronic glomerulonephritis.

It's important to note that in many individuals with chronic glomerulonephritis, the exact cause of the disease may not be known. Here are some medical conditions that have been studied as potential causes of chronic glomerulonephritis:

• IgA nephropathy a kidney disorder that occurs when there is a buildup of IgA antibodies in the kidneys.
• Hereditary nephritis, a spectrum of diseases that cause progressive kidney impairment, hearing loss, and vision problems, is typically found in young males.
• Infections

Risk factor

Risk factors that increase the likelihood of chronic glomerulonephritis include:

• A history of acute glomerulonephritis
• Certain autoimmune diseases (conditions where the body's immune cells attack healthy cells)
• A history of cancer
• Exposure to certain hydrocarbon solvents
• Genetic factors, although not yet fully understood; chronic glomerulonephritis is sometimes inherited in families.

Symptoms

Chronic glomerulonephritis can develop without noticeable symptoms or clinical signs, leading to a lack of awareness of the condition in some individuals for an extended period. Symptoms can vary in severity. However, if present, they may include:

• Swelling in the face or ankles
• Foamy urine resembling dishwashing soap
• Presence of blood or red appearance in urine
• Frequent nighttime urination
• Abdominal pain
• High blood pressure

Diagnosis 

The diagnosis of chronic glomerulonephritis typically begins with a medical interview followed by physical examinations. During the interview, the doctor gathers detailed information about your symptoms and any complaints you may have. They also inquire about your medical history and any medications you may have taken to alleviate your symptoms. Additionally, the doctor conducts a physical examination, focusing on the symptoms you have described. In cases of chronic glomerulonephritis, the examination may reveal signs such as high blood pressure and swelling in the face or lower limbs.

Diagnostic tests play a crucial role in establishing the diagnosis. These tests include laboratory tests, imaging, and, in some cases, biopsies. Common laboratory tests performed may include:

• Complete blood count, electrolyte levels, and albumin levels in the body.
• Complete urine analysis to check for red blood cells, excessive protein, signs of infection, etc., in your urine.
• Kidney function tests, such as creatinine and blood urea, are used to assess the condition of the kidneys, whether they can still function properly, or if there is a decline in function due to widespread glomerular inflammation.
• Glomerular filtration rate, a test to assess and monitor kidney function in filtering metabolic waste products.

Imaging examinations such as ultrasound (USG) and CT scans of the kidneys can also be performed to visualize the size and shape of the kidneys and detect any abnormalities.

A biopsy is the most accurate and invasive examination to confirm the diagnosis, determine the cause of glomerulonephritis, and assess the severity of the disease. During a biopsy, the doctor inserts a needle through the abdomen into the kidney to obtain a sample of kidney tissue. This tissue sample is then analyzed to identify any signs of kidney damage.

Management

There is no specific therapy or treatment for chronic glomerulonephritis. Patients are strongly advised to monitor their weight and their intake of fluids, protein, potassium, and salt from the foods they consume. Reducing protein and salt intake and limiting fluids are beneficial in slowing down kidney deterioration. Additionally, controlling and reducing blood pressure is crucial to prevent worsening of the condition.

Doctors may prescribe blood pressure-lowering medications, calcium supplements, and diuretics to address facial and ankles swelling. All medications that have the potential to impair kidney function need to have their doses adjusted depending on the severity of chronic glomerulonephritis. In cases where chronic glomerulonephritis progresses to kidney failure, dialysis therapy or even a kidney transplant may be necessary, depending on the severity of the disease.

Complications

Some complications that may occur generally can indicate the need for prompt dialysis, including:

• Metabolic acidosis: A serious electrolyte imbalance characterized by an acid-base imbalance in the body.
• Pulmonary edema is a fluid buildup in the lungs causing difficulty breathing.
• Pericarditis: Inflammation of the membrane surrounding the heart.
• Uremic encephalopathy: A brain disorder due to toxin accumulation from kidney disease.
• Hypocalcemia: Decreased calcium levels in the body.
• Hyperkalemia: Increased potassium levels in the body.
• Severe anemia.

Prevention

Chronic glomerulonephritis is a long-lasting inflammation in the kidneys. To prevent the worsening of the disease, you can:

• Control blood pressure levels to prevent kidney damage.
• Limit protein and salt intake.
• Maintain a healthy weight by reducing overweight.
• Exercise regularly.

When to see a doctor?

If you're experiencing worsening symptoms, such as persistent blood in the urine and increasing swelling in the ankles and feet throughout the day, it's advisable to consult with an internal medicine doctor (Internist). The doctor will conduct a medical interview, a physical examination, and specific diagnostic tests to establish an accurate diagnosis of the underlying condition and plan appropriate management tailored to your needs.

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