Chronic Glomerulonephritis

Chronic glomerulonephritis is a long-term kidney condition that develops slowly over months or years, causing progressive damage to the tiny filtering units inside your kidneys. If left untreated, it can lead to serious complications including kidney failure.

Table of contents

• What is chronic glomerulonephritis?
• What causes chronic glomerulonephritis?
• Signs and symptoms
• Possible complications
• How is it diagnosed?
• Treatment approaches
• Prevention and lifestyle changes

What is chronic glomerulonephritis?

Chronic glomerulonephritis is a type of kidney disease that develops slowly over time. It involves damage to the glomeruli, which are tiny filtering units inside your kidneys made of small blood vessels called capillaries. Each kidney contains almost a million of these glomeruli, and their main job is to remove waste and extra fluid from your blood.^[1]

When you have chronic glomerulonephritis, inflammation damages these filters gradually. Unlike acute glomerulonephritis, which starts suddenly, the chronic form happens slowly and lasts a long time. Some people can have an acute attack and then develop a chronic condition years later.^[1]

The condition is characterized by irreversible and progressive damage to the glomeruli and surrounding kidney tissue, ultimately leading to a reduction in the glomerular filtration rate (GFR), which measures how well your kidneys are filtering blood. This leads to retention of toxic waste products in the body.^[2]

Chronic glomerulonephritis is the third leading cause of chronic kidney disease, and it accounts for about 10% of all patients on dialysis for end-stage kidney disease.^[2]

What causes chronic glomerulonephritis?

Nearly all forms of acute glomerulonephritis have a tendency to progress to chronic glomerulonephritis.^[2] The progression from acute to chronic glomerulonephritis is variable, depending on what caused the condition in the first place.^[2]

The reason glomerulonephritis develops is often unknown. However, several causes and risk factors have been identified:^[1]

• Infections: Complications of bacterial infections like strep throat, HIV, or hepatitis C can trigger the condition. Bacterial endocarditis, an infection in your heart valves, can also lead to glomerulonephritis.
• Autoimmune conditions: Problems with your immune system attacking healthy parts of your body, such as with lupus, can damage the kidneys. Anti-GBM disease (formerly Goodpasture syndrome) affects both lungs and kidneys.
• IgA nephropathy: A kidney disease caused by a buildup of abnormal IgA antibody (immunoglobulin A).
• Blood vessel inflammation: Rare diseases that inflame blood vessels like granulomatosis with polyangiitis (formerly Wegener’s disease), microscopic polyangiitis, Henoch-Schönlein purpura, or eosinophilic granulomatosis with polyangiitis (formerly Churg-Strauss syndrome).
• Genetics: In rare cases, the condition runs in families.
• Cancer: Certain types of cancer like multiple myeloma can be associated with glomerulonephritis.

Additional risk factors include a personal or family history of kidney disease, taking certain medications, exposure to specific toxins, and having an autoimmune condition.^[1]

Signs and symptoms

People with chronic glomerulonephritis often don’t experience any warning signs of the disease, especially in the early stages. Chronic glomerulonephritis can take several months to years to develop, and a person might not notice it right away unless a doctor tests for it.^[3]

When symptoms do appear, they can include:^[1]

• Blood in your urine (hematuria): Your urine may look brown, pink, or red due to the presence of blood.
• Protein in your urine (proteinuria): Your urine may appear foamy or bubbly.
• Swelling (edema): Fluid buildup can cause swelling in your legs, face, hands, or feet, especially in the morning.
• High blood pressure (hypertension): Kidney damage can lead to elevated blood pressure.
• Urination changes: Peeing less often or more often than usual.
• General symptoms: Nausea, shortness of breath, rash, pain in your joints or abdomen, jaundice, weight loss, or loss of appetite.

Your first indication that something is wrong might come from the results of a routine urine test.^[3]

Possible complications

Without timely treatment, chronic glomerulonephritis can progress and lead to serious complications. When the glomerular filtration rate decreases, it results in:^[2]

• Azotemia: A rise in blood urea nitrogen (BUN) and serum creatinine levels, which becomes apparent when the GFR decreases to less than 60-70 mL/min.
• Anemia: Decreased production of erythropoietin, a hormone that helps make red blood cells, resulting in anemia.
• Bone problems: Decreased production of vitamin D, resulting in low calcium levels, secondary hyperparathyroidism, high phosphate levels, and renal bone disease.
• Fluid and electrolyte imbalances: Reduced ability to remove acid, potassium, salt, and water, resulting in acidosis, high potassium levels, high blood pressure, and swelling.
• Bleeding tendency: Problems with platelet function, leading to increased bleeding tendency.
• Uremia: Accumulation of toxic waste products that affects virtually all organ systems. Uremia occurs at a GFR of approximately 10 mL/min.

If disease progression is not stopped with therapy, the results are chronic kidney disease (CKD), end-stage kidney disease (ESKD), and cardiovascular disease.^[2]

How is it diagnosed?

Glomerulonephritis may be identified with tests if you have an illness or during routine testing during a wellness visit or an appointment managing a chronic disease. Tests to assess your kidney function and make a diagnosis include:^[10]

• Urine test (urinalysis): A urinalysis can reveal signs of poor kidney function, such as red blood cells and proteins that should not be in urine, or white blood cells that are a sign of inflammation.
• Blood tests: Analysis of blood samples can reveal higher than expected levels of waste products in the bloodstream, the presence of antibodies that may indicate an autoimmune disorder, bacterial or viral infection, or blood sugar levels indicating diabetes.
• Imaging tests: If your doctor detects evidence of kidney disease, they may recommend imaging tests that may show an irregularity in the shape or size of the kidney. These tests may be an X-ray, an ultrasound exam, or a CT scan.
• Kidney biopsy: This procedure involves using a special needle to extract small pieces of kidney tissue to look at under a microscope. A biopsy is used to confirm a diagnosis and to assess the degree and nature of tissue damage.

Treatment approaches

Treatment for chronic glomerulonephritis depends on the cause and severity of the condition. The goals are to slow disease progression, manage complications, and preserve kidney function as much as possible.^[9]

Medications

Several types of medications may be prescribed:^[9]

• Blood pressure control: ACE inhibitors (angiotensin-converting enzyme inhibitors) or ARBs (angiotensin receptor blockers) help lower blood pressure and reduce the amount of protein that leaks into your urine. Often, people who have high blood pressure and kidney disease need to take several medicines to control their blood pressure.^[8]
• Diuretics: Loop diuretics help manage swelling caused by fluid buildup in the body.^[8]
• Immunosuppressants: If glomerulonephritis is caused by problems with your immune system, medicines called immunosuppressants may be recommended. These medicines suppress your immune system and can include steroids such as prednisolone.^[8]
• Cholesterol-lowering medicines: Statins are frequently used to reduce cholesterol and help protect against complications such as heart and vascular disease.^[8]
• SGLT2 inhibitors: Sodium-glucose cotransporter-2 inhibitors may be beneficial for reducing proteinuria.^[9]

Other treatments

In certain circumstances, additional treatments may be necessary:

• Plasma exchange: This procedure involves removing some of the plasma from your blood. The plasma is separated from the blood cells and removed, and a plasma substitute is then added to the blood before it’s put back into your body. Plasma exchange may be used if your condition is severe.^[8]
• Dialysis: If you have severe glomerulonephritis that cannot be improved with other treatments, you may require kidney dialysis, a treatment that takes over part of the kidney’s job and removes waste products from your body.^[8]
• Kidney transplant: In advanced cases, a kidney transplant, where a healthy kidney from a donor is surgically implanted to replace your own kidney, may be necessary.^[8]

Prevention and lifestyle changes

While you cannot always prevent chronic glomerulonephritis, certain lifestyle changes can help manage the condition and slow its progression:

Dietary changes

A dietitian can help you make an eating plan. You may be advised to:^[8]

• Reduce the amount of salt, fat, protein, and potassium in your diet
• Drink less fluid
• Monitor phosphorus and potassium intake

This should help control your blood pressure and ensure the amount of fluid in your body is regulated.^[8]

Lifestyle modifications

• Stop smoking: Smoking may make kidney disease caused by glomerulonephritis worse. It also increases the risk of complications like heart disease and stroke, which are more common in people with glomerulonephritis.^[8]
• Stay physically active: Regular exercise helps maintain overall health and blood pressure.
• Maintain a healthy weight: In obese patients, weight reduction may have beneficial effects on chronic kidney disease.

Medical follow-up

You should have regular reviews to check your blood pressure, the levels of salt and potassium in your urine, and how well your kidneys are working.^[8] All potentially harmful medications must be adjusted for the degree of chronic kidney disease.^[9]

As glomerulonephritis can make you more vulnerable to infections, it’s a good idea to protect yourself by having a seasonal flu vaccine and a pneumonia vaccine (also called the pneumococcal vaccine).^[8]