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Glomerulonephritis Center of Excellence

GLOMERULONEPHRITIS

Why choose the Florida Kidney Physicians Glomerulonephritis Center of Excellence?

Because FKP has dedicated experts that specialize in Glomerulonephritis.
Dr. Marc Richards, the Head of the FKP Center of Excellence, performed his nephrology fellowship at the University of North Carolina Kidney Center, one of the nation's most renowned academic centers for diagnosing, treating, and managing glomerular diseases. He brings this expertise into our community, where he has treated these conditions since 2013, utilizing an array of techniques ranging from conservative management to the latest medication advances.

Autoimmune disorders which cause Glomerulonephritis require cohesive management amongst many different types of medical specialists. Dr. Richards will work as a team with other physicians throughout the community to provide comprehensive, compassionate, and supportive care. In addition, Dr. Richards has relationships with many experts in the field at academic medical centers throughout the country and will utilize these connections to assist with enrollment in clinical trials to guarantee access to the latest treatment options.

Overview

Glomerulonephritis (GN) is a type of kidney disease caused by damage and inflammation to the filtering units within your kidneys, called glomeruli. These consist of tightly bound bundles of small blood vessels called capillaries amongst other structures which act as filters, allowing for the transfer of waste and liquid out of your blood as urine.

When these filters are damaged, your kidneys lose their ability to filter efficiently, often causing notable symptoms such as dark or tea-colored urine, bubbly or foamy urine, leg or facial swelling, and elevated blood pressure. pressure. Although often treatable, severe glomerulonephritis and the associated damage to your kidneys can lead to acute or chronic kidney failure which may require dialysis or kidney transplant.

Glomerulonephritis can present as a sudden acute disorder or can progress slowly over many years. It can be caused by infections, autoimmune disorders, or from other systemic illnesses like diabetes.

Symptoms and Causes

Symptoms

The early symptoms of acute glomerulonephritis include:

  • Swollen face, abdomen, or legs
  • Hematuria - Blood in urine, urine will look brown, pink, or red, unrelated to diet
  • Less frequent urination
  • Shortness of breath
  • Rash that can be felt with your hands
  • The symptoms of chronic glomerulonephritis include:
  • Hematuria - Blood in urine, urine will look brown, pink, or red, unrelated to diet
  • Fatigue
  • High blood pressure
  • Swelling in the ankles, face, hands, or abdomen
  • Painful joints or abdomen
  • Frequent urination at night
  • Urine that is very foamy or bubbly


Untreated for long enough, glomerulonephritis can cause kidney failure. Symptoms of kidney failure include:

  • Fatigue
  • Trouble sleeping
  • Nausea
  • Vomiting
  • Loss of appetite
  • Dry, itchy skin
  • Muscle cramping at night

Causes and risk factors

There can be many causes, or risk factors, for developing glomerulonephritis and they can differ for chronic and acute variations. Some of the most common causes are related to infections or autoimmune disorders. There is also evidence linking exposure to hydrocarbon solvents as a risk factor for developing GN.

High blood pressure: a long-term history of hypertension can create scarring and swelling of the glomeruli - this becomes a feedback loop because glomerulonephritis impairs the kidney’s ability to regulate blood pressure.

Diabetes: Diabetes can lead to diabetic nephropathy, a condition caused by damage and scarring to the kidneys and glomeruli from high blood glucose levels.

Hepatitis: Hepatitis B and hepatitis C can cause inflammation of the kidneys as well as the glomeruli
Analgesic nephropathy: Overuse of pain-relieving medications acetaminophen, aspirin, and NSAIDs can lead to glomerular disease.

Bacterial endocarditis: Bacterial infection of your heart’s valves, or infective endocarditis, can cause glomerulonephritis.

HIV: HIV-associated nephropathy can occur in patients with HIV who do not adhere with prescribed antiviral regimens.

Focal segmental glomerulosclerosis: Systemic conditions in your body or kidney disease can cause scarring throughout your kidneys.

Lupus: The autoantibodies produced by lupus can attack your kidneys, causing lupus nephritis
IgA nephropathy: Immunoglobulin A can accumulate in the glomeruli, causing inflammation and damage.

Polyarteritis: A type of vasculitis, or inflammation of the blood vessels, polyarteritis can inflame the small to medium sized vessels in your kidneys, as well as the skin, muscles, and digestive tract.

Anti-GBM Disease: A rare immune disorder where antibodies attack the lungs and kidneys.
ANCA Associated Vasculitis: This form of vasculitis affects the small-sized blood vessels in your upper and lower respiratory tract plus your kidneys.

Strep Throat: Can trigger acute post-streptococcal glomerulonephritis, where antibodies can build up within your glomeruli, causing inflammation.

Impetigo: Another infection caused by streptococcal bacteria, impetigo is a contagious skin infection that occurs most commonly in children and can trigger acute GN.

Cancer: Solid tumors and blood-based tumors such as leukemia, lymphoma, and multiple myeloma can cause glomerular disease.

Autoimmune Disease: Different rheumatologic conditions such as Sjogrens Disease, scleroderma, and rheumatoid arthritis can also cause GN.

Genetics: Sometimes the risk factors of glomerulonephritis are hereditary and passed down through generations.

Diagnosis and Treatment

Diagnosis

Blood and urinalysis testing can determine how your kidneys are functioning. A serum creatinine combined with a glomerular filtration rate (GFR), can estimate your kidney function. A serum albumin test can measure, protein levels in your blood, which if low suggests that the kidneys could be leaking excessive amounts of protein. A urinalysis checks your urine for the presence of red and white blood cells, or for high levels of protein.

If glomerulonephritis is suspected by your doctor, diagnostic imaging like an ultrasound, CT scan or MRI can estimate the size and function of your kidneys, plus look for structural problems or obstruction.

In many instances, a kidney biopsy is required; a tiny piece of your kidney is removed with a needle, often by an interventional radiologist, for testing. The results from a biopsy are very important since they can determine the extent of damage done to your kidneys as well as the type of kidney disease, which makes determining treatment options much more straightforward.

Treatment

Glomerulonephritis can either respond well to therapies or it can become progressively worse. In some acute glomerulonephritis cases, such as ones resulting from an infection, treatment often is not needed as the condition can improve on its own. In cases where an underlying cause still exists such as diabetes or hypertension, steps for treatment will go towards those conditions with the goal being the preservation of kidney function, since these conditions are chronic and cause ongoing damage.

Glomerulonephritis caused by viral infections such as hepatitis C and B can be treated by treating the ongoing symptoms of hepatitis.
If you have high cholesterol and GN, treating your high cholesterol can prevent further complications such as heart and vascular disease through the use of statins. Statins are medications that help to reduce low-density cholesterol in your blood.

Your doctor may recommend changes in your diet to avoid protein, potassium and salt. A diuretic can be prescribed for symptoms like fluid retention and swelling.

Glomerulonephritis causes high blood pressure which further increases the damage done to your kidneys. Your doctor will monitor your blood pressure carefully while you are undergoing treatment. To reduce blood pressure you may be prescribed angiotensin-converting enzyme inhibitors or angiotensin receptor blockers - both classes of medications lower blood pressure by easing pressure on the blood vessels in the kidney.

Severe cases require the use of immunosuppressants which weaken your immune system and reduce inflammation. Your doctor may prescribe a steroid such as prednisone. Corticosteroids reduce swelling as well as dampens your immune system. Usually, doses are very high at the time of diagnosis, but the dosage of steroids may be lowered once your kidneys begin to recover. In addition, other classes of immunosuppressants may be used and given by mouth or intravenously.

In rare cases, proteins in your blood’s plasma are what trigger your kidneys to become inflamed. Total Plasmapheresis Exchange (TPE) or plasma exchange removes plasma from your blood and exchanges it with a plasma substitute to lessen the number of harmful proteins. This is performed in conjunction with other treatments.

Severe cases of glomerulonephritis are progressive and can lead to chronic kidney disease, reduced kidney function, and end-stage kidney disease. When kidney function falls below 10% of normal, kidney replacement therapy is required- either via dialysis or a kidney transplant.

Dialysis is not a cure for kidney disease but instead functions as a mechanical kidney to remove waste that your kidneys can’t.

Hemodialysis is a form of dialysis that filters your blood outside of your body in a dialyzer. The process usually involves receiving treatments at a dialysis center for 3-4 hour sessions up to three times per week.

Peritoneal dialysis uses a small machine that is connected to a tube in your abdomen. Several times a day the machine passes a solution into your abdomen that soaks up waste and fluids, which then drains into a collection bag outside the body.

Kidney transplants are the preferred method of kidney replacement therapy because they will often approximate normal kidney function and keep patients off dialysis. Treatments involve the use of immunosuppressants, many of which can also be used to treat your initial glomerular disease.

Unfortunately, sometimes glomerular disease can return and affect your transplant. This will be followed closely by your nephrologists and transplant team.

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