Glomerulonephritis is a disorder of glomeruli (clusters of microscopic blood vessels in the kidneys with small pores through which blood is filtered). It is characterized by body tissue swelling (edema), high blood pressure, and the presence of red blood cells in the urine.
Glomerulonephritis can be caused by various disorders, such as infections, an inherited genetic disorder, or autoimmune disorders.
Diagnosis is based on tests of blood and urine and sometimes imaging tests, a biopsy of the kidneys, or both.
People often need to restrict salt and protein intake and take diuretics, antibiotics, or immunosuppressants until kidney function improves.
(See also Overview of Kidney Filtering Disorders.)
Glomerulonephritis can be
Acute: Develops over a short time
Chronic: Develops and progresses slowly
In 1% of children and 10% of adults who have acute glomerulonephritis, it evolves into rapidly progressive glomerulonephritis, in which most of the glomeruli are destroyed, resulting in kidney failure.
Causes of Glomerulonephritis
Glomerulonephritis can be
Primary, originating in the kidneys
Secondary, caused by a vast array of disorders
The disorders that cause secondary glomerulonephritis may affect parts of the body other than the kidneys.
Acute glomerulonephritis
Acute glomerulonephritis most often occurs as a complication of a throat or skin infection with streptococcus (for example, strep throat), a type of bacteria. Acute glomerulonephritis that occurs after a streptococcal infection (poststreptococcal glomerulonephritis) typically develops in children between the ages of 2 and 10 after recovery from the infection. Infections with other types of bacteria, such as staphylococcus and pneumococcus, viral infections, such as chickenpox, and parasitic infections, such as malaria, can also result in acute glomerulonephritis. Acute glomerulonephritis that results from any of these infections is called postinfectious glomerulonephritis.
Acute glomerulonephritis may also be caused by noninfectious disorders, including membranoproliferative glomerulonephritis, immunoglobulin A (IgA) nephropathy, immunoglobulin A–associated vasculitis, systemic lupus erythematosus (lupus), cryoglobulinemia, Goodpasture syndrome, granulomatosis with polyangiitis, and microscopic polyangiitis. Acute glomerulonephritis that develops into rapidly progressive glomerulonephritis most often results from conditions that involve an abnormal immune reaction.
Chronic glomerulonephritis
Often, chronic glomerulonephritis seems to result from some of the same conditions that cause acute glomerulonephritis, such as IgA nephropathy or membranoproliferative glomerulonephritis. Sometimes, acute glomerulonephritis does not resolve and instead becomes long lasting (chronic). Occasionally, chronic glomerulonephritis is caused by hereditary nephritis, an inherited genetic disorder. In many people with chronic glomerulonephritis, the cause cannot be identified.
Symptoms of Glomerulonephritis
About half of the people with acute glomerulonephritis have no symptoms. If symptoms do occur, the first to appear are tissue swelling (edema) due to fluid retention, low urine volume, and production of urine that is dark because it contains blood. Edema may first appear as puffiness of the face and eyelids but later is prominent in the legs. Blood pressure increases (see The Body's Control of Blood Pressure) as kidney function becomes impaired. Some people become drowsy or confused. In older people, nonspecific symptoms, such as nausea and a general feeling of illness (malaise), are more common.
When rapidly progressive glomerulonephritis develops, weakness, fatigue, and fever are the most frequent early symptoms. Loss of appetite, nausea, vomiting, abdominal pain, and joint pain are also common. About 50% of people have a flu-like illness in the month before kidney failure develops. These people have edema and usually produce very little urine. High blood pressure is uncommon and rarely severe when it does occur.
Because chronic glomerulonephritis usually causes only very mild or subtle symptoms, it goes undetected for a long time in most people. Edema may occur. High blood pressure is common. The disease may progress to kidney failure, which can cause itchiness, decreased appetite, nausea, vomiting, fatigue, and difficulty breathing.
Diagnosis of Glomerulonephritis
Blood tests
Urine tests
Kidney biopsy
Doctors investigate the possibility of acute glomerulonephritis in people who develop symptoms that suggest the disorder. They also investigate the possibility in people whose laboratory test results (which may be done to evaluate nonspecific symptoms or as part of a routine medical evaluation) indicate kidney dysfunction or blood in the urine. Laboratory tests show variable amounts of protein and blood cells in the urine. Blood tests show a high concentration of urea and creatinine (waste products) in the blood.
In people with rapidly progressive glomerulonephritis, casts are often visible in a urine sample that is examined under a microscope. Casts are clumps of red blood cells or white blood cells, caused by damage to the glomerulus and formed by cells sticking together in the tubule. Blood tests usually detect anemia.
When doctors suspect glomerulonephritis, a biopsy of a kidney is usually done to confirm the diagnosis, help determine the cause, and determine the amount of scarring and potential for reversibility. Kidney biopsy is done by inserting a needle in one of the kidneys under ultrasound or computed tomography (CT) guidance to obtain a small amount of kidney tissue. Although kidney biopsy is an invasive procedure and occasionally can cause complications, it is usually safe.
Chronic glomerulonephritis develops gradually, and therefore, a doctor may not be able to tell exactly when it began. It may be discovered when a urine test, done as part of a medical examination, reveals the presence of protein and blood cells in the urine in a person who is feeling well, has normal kidney function, and has no symptoms. Doctors usually do an imaging test of the kidneys, such as ultrasonography or CT.
A kidney biopsy is the most reliable way to distinguish chronic glomerulonephritis from other kidney disorders. A biopsy, however, is rarely done in advanced stages. In these cases, the kidneys are shrunken and scarred, and the chance of obtaining specific information about the cause is small. Doctors suspect that the kidneys are shrunken and scarred if kidney function has been poor for a long time and the kidneys appear abnormally small on an imaging test.
Determining the cause of glomerulonephritis
Additional tests are sometimes helpful for identifying the cause. For example, in the diagnosis of postinfectious glomerulonephritis, a throat culture may provide evidence of streptococcal infection. Blood levels of antibodies against streptococci may be higher than normal or progressively increase over several weeks. Acute glomerulonephritis that follows an infection other than strep throat is usually easier to diagnose because its symptoms often begin while the infection is still obvious. Cultures and blood tests that help identify the organisms that cause these other types of infections are sometimes needed to confirm the diagnosis.
When doctors suspect an autoimmune cause for glomerulonephritis, they do blood tests for antibodies directed against some of the body's own tissues (called autoantibodies) and tests that assess the complement system, a system of proteins involved in the body's immune system.
Treatment of Glomerulonephritis
Treating the causative disorder
For rapidly progressive glomerulonephritis, suppression of the immune system
Acute glomerulonephritis
No specific treatment is available in most cases of acute glomerulonephritis. The disorder causing glomerulonephritis is treated when possible. Following a diet that is low in protein and sodium may be necessary until kidney function recovers. Diuretics may be prescribed to help the kidneys excrete excess sodium and water. High blood pressure needs to be treated.
When a bacterial infection is suspected as the cause of acute glomerulonephritis, antibiotics are usually ineffective because the nephritis begins 1 to 6 weeks (average, 2 weeks) after the infection, which has, by then, usually resolved. However, if a bacterial infection is still present when acute glomerulonephritis is discovered, antibiotic therapy is started. Antimalarial medications may be beneficial if glomerulonephritis is caused by malaria.
Some autoimmune disorders that cause glomerulonephritis are treated with corticosteroids and sometimes with other medications that also suppress the immune system.
Rapidly progressive glomerulonephritis
plasma exchange is sometimes used to remove antibodies from the blood. The sooner treatment occurs, the less likely are kidney failure and the need for dialysis. Kidney transplantation is sometimes considered for people who develop chronic kidney disease with kidney failure, but rapidly progressive glomerulonephritis may recur in the transplanted kidney.
Chronic glomerulonephritis
Taking either an ACE inhibitor or an ARB often slows progression of chronic glomerulonephritis and tends to reduce blood pressure and the excretion of protein in the urine. Reducing blood pressure and sodium intake are considered beneficial. Restricting the amount of protein in the diet is modestly helpful in reducing the rate of kidney deterioration. End-stage kidney disease (ESKD) can be treated with dialysis or a kidney transplant.
Prognosis for Glomerulonephritis
Acute poststreptococcal glomerulonephritis resolves completely in most cases, especially in children. About 1% of children and 10% of adults develop chronic kidney disease.
The prognosis for people with rapidly progressive glomerulonephritis depends on the severity of glomerular scarring and whether the underlying disease, such as infection, can be cured. In some people who are treated early (within days to weeks), kidney function is preserved and dialysis is not needed. However, because the early symptoms can be subtle and vague, most people who have rapidly progressive glomerulonephritis are not aware of the underlying disease and do not seek medical care until kidney failure develops.
If treatment occurs late, the person is more likely to develop chronic kidney disease with kidney failure. Because kidney failure tends to develop before people notice it, 80 to 90% of people who have rapidly progressive glomerulonephritis become dependent upon dialysis. The prognosis also depends on the cause, the person's age, and any other diseases the person might have. When the cause is unknown or the person is older, the prognosis is worse.
In some children and adults who do not recover completely from acute glomerulonephritis, other types of kidney disorders develop, such as asymptomatic proteinuria and hematuria syndrome or nephrotic syndrome. Other people with acute glomerulonephritis, especially older adults, often develop chronic glomerulonephritis.
Primary Glomerular Disorders That Can Cause Glomerulonephritis
Disorder | Description | Prognosis |
|---|---|---|
Fibrillary glomerulonephritis | In this rare disease, abnormal proteins are deposited around the glomerulus. It may also cause nephrotic syndrome. | The prognosis is poor. A severe decline in kidney function (end-stage kidney disease [ESKD]) occurs in half of people within 4 years. It is not clear whether treatment (with corticosteroids and other immunosuppressants) helps. |
Immunoglobulin A (IgA) nephropathy | The most common form of glomerulonephritis in the world is caused by immune complexes (combinations of antigens and antibodies) deposited in the kidneys. Antibodies are proteins made by the body to attack specific molecules called antigens. | Usually the disorder progresses slowly. ESKD develops in about 25% of people after 20 years. The disorder progresses more slowly in children. |
Membranoproliferative glomerulonephritis | This uncommon type of glomerulonephritis occurs primarily between the ages of 8 and 30. The disorder is caused by immune complexes (combinations of antigens and antibodies) attaching to the kidneys, but sometimes why the complexes attach to the kidneys is unknown. | If the cause is known and can be treated (eg, malaria, multiple myeloma), a partial remission may occur. The outcome is not as good in people in whom the cause remains unknown. About half of people progress to ESKD within 10 years, and 90% within 20 years. |
Primary rapidly progressive glomerulonephritis | This group of disorders causes microscopic damage to the glomeruli and progress rapidly. Sometimes they are caused by an infection or other treatable disorder. Kidney biopsy is required for diagnosis. | The prognosis is poor. At least 80% of people who are not treated develop ESKD within 6 months. The prognosis is better for people younger than 60 years and when an underlying disorder causing the glomerulonephritis responds to treatment. |
More Information
The following English-language resources may be useful. Please note that THE MANUAL is not responsible for the content of these resources.
American Kidney Fund, Glomerulonephritis: General information on glomerulonephritis, including answers to frequently asked questions
National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), Glomerular Diseases: General information on glomerular diseases, including the roles of glomeruli in normal kidney function, chronic kidney disease, and nephrotic syndrome
