What is Glomerulonephritis?

While your kidneys may not be at the forefront of your thoughts, they play a vital role in maintaining your overall well-being. They filter and purify your blood, getting rid of excess water, salts and other waste products. They also help keep your bones healthy and are involved in controlling your blood pressure. Your kidneys play a crucial role in preventing the onset of anemia—a condition marked by a shortage of blood cells or insufficient hemoglobin in your red blood cells. For a more in-depth exploration of anemia and iron deficiency, refer to our detailed guide here.

 

What can cause kidney problems?

Unfortunately there are several things that can affect the health of your kidneys – take a look at our guide to kidney problems for some examples. Even your own immune system can mistakenly attack your kidneys’ cells and tissues. When this happens the condition is called glomerulonephritis, though some people refer to it as autoimmune kidney disease.
 
We don’t know exactly why the immune system acts in this way in some people. According to the British Society for Immunology, those with autoimmune diseases have a defect that makes them unable to distinguish ‘self’ from ‘non-self’ or ‘foreign’ molecules – in other words their immune systems don’t just attack pathogens (disease-causing microorganisms      such as viruses and bacteria) but they attack the cells and tissues they’re meant to protect too (i).
 
For more information, head to our guide to autoimmune conditions including some of the other most common types like: rheumatoid arthritis, lupus, psoriasis, type 1 diabetes, coeliac disease and Hashimoto’s disease. 

 

Autoimmune kidney disease      

 
There are a few other types of autoimmune kidney disease, but the most common is glomerulonephritis. It gets its name from the glomerulus, which is a tiny filtration unit found in your kidneys (there are about a million glomeruli in each kidney), and from the inflammation in the kidneys (nephritis) caused by the attacking immune system.
 

Causes of glomerulonephritis

 
While autoimmunity is very often the cause of glomerulonephritis, other things can damage the glomeruli too, such as:       
 

• high blood pressure

• diabetes

• HIV

• hepatitis

• endocarditis (infection of the inner lining of the heart)

• certain blood disorders

• tuberculosis (TB)

• infections including viral infections and streptococcal throat infections (ii).

• genetics

• hormonal imbalances

• imbalance of gut bacteria (iii).

 

Glomerulonephritis symptoms

 
According to Kidney Research UK, many people with glomerulonephritis have no symptoms and feel completely well (iv). However there may be tiny amounts of blood or protein in their urine that slipped through the damaged glomeruli – these can only be detected by having a urine test. If more blood is lost through the glomeruli you may be able to actually see it in your urine, or the urine may look frothy if more protein is lost through the filters.
 
Some people with glomerulonephritis develop another condition called nephrotic syndrome, which causes fluid retention in the body (this may, for instance, cause swelling in your legs and other parts of your body).
 
The NHS claims the following are also symptoms of glomerulonephritis (depending on what’s causing it) (v):
 

• Skin rashes

• Joint pain

• Stomach pain

• High temperature

• Shortness of breath

• Jaundice (yellowing of the whites of the eyes or the skin, though this isn’t always easy to spot on darker skin)

• Unusually frequent urination

• Tiredness

• Poor appetite and weight loss

 
Some people with glomerulonephritis can also develop high blood pressure.
 

How long does glomerulonephritis last?

 
The good news is that glomerulonephritis usually gets better in time, with more than 98 per cent of those affected having no symptoms after five years (vi). A very small number of people with glomerulonephritis, however, will experience permanent damage to their kidneys, in time developing chronic kidney disease and even kidney failure (experts suggest 10 to 15 per cent of end-stage kidney disease is caused by glomerulonephritis (vi)).
 

Types of glomerulonephritis

 
Glomerulonephritis isn’t a single condition – in fact it’s the name for a group of kidney diseases. These include the following:
 

Acute glomerulonephritis

 
Glomerulonephritis can be acute, which means it starts suddenly and doesn’t last for long, or chronic, where it lasts for longer. The glomeruli are very delicate structures and can be easily damaged. So if you have chronic glomerulonephritis it can cause irreversible damage, which means your kidneys won’t work properly and you may develop chronic kidney disease or even kidney failure. As well as acute and chronic glomerulonephritis there are other ways to classify the condition:
 

• Primary glomerulonephritis  —  This is glomerulonephritis that develops on its own (idiopathic)

• Secondary glomerulonephritis  —  When it’s secondary, glomerulonephritis is triggered by another existing condition or disease (read on for more details)

 

Focal and segmental glomerulosclerosis

 
With this type of glomerulonephritis the glomeruli become scarred or hardened. However only some of the glomeruli are affected, and those that are affected are only damaged in part, rather than all over. Sometimes FSGS goes away on its own, but it often continues unchanged for many years. Fluid retention can develop (nephrotic syndrome) and some cases may progress to kidney failure. According to the National Kidney Federation, in most cases FSGS doesn’t affect normal life (vii).
 

IgA glomerulonephritis

 
This is the result of an antibody produced by the immune system called immunoglobin A (IgA) as well as other antibodies being deposited in the kidneys, leading to inflammation, scarring and damage. Also called IgA nephropathy or Berger’s disease, it can only be diagnosed after a kidney biopsy, where a sample of kidney tissue is analysed under a microscope. Symptoms of IgA nephropathy include high blood pressure, nephrotic syndrome, a blotchy red rash (this happens with a variant called Henoch-Schonlein purpura) and kidney failure. Most people with IgA nephropathy lead a normal life (though, as with other kidney diseases you should discuss it with your GP if you plan to become pregnant).
 

IgM glomerulonephritis

 
This is also caused by an antibody settling in the kidney and causing scarring and inflammation. In this case the antibody is called immunoglobin M (IgM). In most cases there aren’t any symptoms, but some blood or protein may leak into the urine. Complications can cause high blood pressure and, occasionally, kidney failure. A few people with IgM nephritis may also experience pain in their kidneys. IgM nephritis doesn’t affect normal life in most cases.
 

Membranoproliferative glomerulonephritis

 
Also called mesangiocapillary glomerulonephritis, MPGN is where the membranes in the glomeruli and a supporting structure called the mesangium become damaged (in other types of glomerulonephritis, only one or the other is affected). Again there are often no symptoms, but some blood and protein may appear in the urine. If enough protein is lost, the result can be nephrotic syndrome. Some people with MPGN can also develop high blood pressure. According to the National Kidney Federation, MPGN can occasionally run in families (viii). However while it can go away of its own accord or continue unchanged for many years, MPGN can develop into kidney failure for many who have it for a long time. Pregnant women with MPGN also need careful monitoring.
 
Membranous glomerulonephritis, meanwhile, is when only the membranes of the glomeruli are damaged (not the mesangium).
 

Minimal change nephropathy

 
This is one of the most common causes of nephrotic syndrome where symptoms include swelling of the ankles, face and hands. Nobody knows exactly what causes it, though we do know that as well as fluid retention it often also causes high blood pressure and high cholesterol. Other possible complications include a higher-than-normal risk of blood clots and infections. It’s called minimal change nephropathy because a sample of kidney tissue taken via a biopsy looks fairly normal under a microscope. If you develop minimal change in nephropathy you may have to rest and take time off while you’re having symptoms, though you should be able to live your life normally when your condition is under control.
 
Minimal change nephropathy is a common type of glomerulonephritis in children (v).
 

Autoimmune conditions and the kidneys

 
Secondary glomerulonephritis can be caused by other autoimmune conditions such as lupus and vasculitis:
 
Vasculitis   When your blood vessels become inflamed, the condition is called vasculitis. This is an autoimmune condition that can be triggered by a number of things, including a viral or bacterial infection or even psychological stress. With vasculitis blood vessels in all parts of the body can become inflamed, including the small blood vessels in the kidneys (when any of the body’s smaller-sized blood vessels are damaged, the condition is often referred to as polyarteritis nodosa). However vasculitis that involves the kidneys is quite rare – according to the National Kidney Federation, just 20 to 30 people per million population develop it each year (ix). If you have vasculitis that affects your kidneys you may need treatment for several years, or even for the rest of your life.
 
Lupus  Systemic lupus erythematosus – or lupus for short – is an autoimmune condition that causes inflammation in your skin, joints and organs, including your kidneys. You can find out more about it in our guide to lupus symptoms and treatments. According to the National Kidney Federation about one in three people with lupus will develop glomerulonephritis (x) (or lupus nephritis as it’s often called). Besides the general lupus symptoms such as tiredness, fatigue, joint pain and skin rashes, the most common symptom of glomerulonephritis in lupus is swelling of the face, arms, legs and abdomen.
 
Meanwhile experts suggest other autoimmune conditions can also affect kidney function, including Sjögren syndrome, scleroderma and rheumatoid arthritis (xi). Goodpasture’s Syndrome – another rare autoimmune condition – can also affect the kidneys and the lungs, causing glomerulonephritis.
 

Glomerulonephritis treatment

 
In mild cases with no noticeable symptoms, glomerulonephritis isn’t usually spotted until you have a blood or urine test to check for something else. Following your urine or blood test, you may need a kidney biopsy to find out which type of glomerulonephritis you have. Once your doctor knows what’s causing it, you could need one or more types of medicines to treat it (and to control any underlying condition if necessary).
 
If you have mild glomerulonephritis you may not need any treatment, though your doctor will usually monitor your condition on a regular basis. You may also be advised to follow a special diet that restricts how much salt and protein you eat.
 

Immunosuppressants

If your symptoms are more severe and autoimmunity has been diagnosed, your doctor or specialist may recommend medicines called immunosuppressants. As their name suggests these suppress your immune system with the aim of preventing it from damaging your kidneys further. However immunosuppressants can increase your risk of developing infections and other side effects, including making your bones weaker.
 

Steroid medicines 

These also help suppress your immune system, plus they can help reduce swelling. But again they can cause side effects, especially when taken long term. As a result, to counteract these side effects you may have to take other medicines.
 

Diuretics

If you’re experiencing a lot of fluid build-up and swelling, you may be advised to take a type of medicine called a diuretic. Sometimes called water pills or water tablets, these help remove excess fluids from the body through urination.
 

Advanced treatments

Some people with severe glomerulonephritis may need a procedure called plasma exchange, where some of the plasma in the blood is removed and replaced with a plasma substitute. If your symptoms become so severe and the usual treatments are no longer helpful, you may need kidney dialysis or a kidney transplant.
 
Meanwhile other medicines that may be helpful include drugs that help control your blood pressure and cholesterol, or medicines called ACE inhibitors to help reduce the amount of protein in your urine (these can also help lower high blood pressure).
 
If you’re taking any prescription medicines, make sure you follow your doctor’s advice and remember to take your medication at the times they recommend. Try to be as clear as possible about how and when to take your medicines, especially if your doctor changes your medicines or their doses. If you’re unsure about what you’re taking and when, always check with your doctor or ask a pharmacist for advice.
 

Want to find out more?

 
There may not be anything you can do to prevent glomerulonephritis or any of the autoimmune conditions that can cause it, but you can take steps to keep your kidneys as healthy as possible – read the section How can I improve my kidney function? in our guide to kidney problems. There’s also lots of information you may find helpful on a wide range of health conditions in our pharmacy health library.

 

References:

1. Available online: https://www.immunology.org/public-information/what-immunology

2. Available online: https://www.uhcw.nhs.uk/download/clientfiles/files/Patient Information Leaflets/Medicine/Renal/Everything I need to know about glomerulonephritis.pdf

3. Available online: https://inkidney.com/glomerulonephrites-the-autoimmune-kidney-diseases/

4. Available online: https://www.kidneyresearchuk.org/conditions-symptoms/glomerulonephritis/

5. Available online: https://www.nhs.uk/conditions/glomerulonephritis/

6. Available online: https://patient.info/kidney-urinary-tract/glomerulonephritis-leaflet

7. Available online: https://www.ncbi.nlm.nih.gov/books/NBK560644/

8. Available online: https://www.kidney.org.uk/iga-nephropathy

9. Available online: https://www.kidney.org/atoz/content/membranoproliferative-glomerulonephritis

10. Available online: https://www.kidney.org.uk/vasculitis

11. Available online: https://www.kidney.org.uk/lupus-and-lupus-kidney-disease

12. Kronbichler, A., Mayer, G.. (2013). Renal involvement in autoimmune connective tissue diseases. BMC Med, 11, 95. Available online: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3616816/

 

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