What happens in the kidneys
Each kidney contains about a million glomeruli - microscopic filters through which blood passes. Their wall is designed to allow water and waste products to pass through, but retain protein and blood cells.
With glomerulonephritis, the immune system attacks the glomeruli: immune complexes are deposited in their walls, inflammation develops, and the filter becomes permeable and damaged. Protein and red blood cells begin to pass into the urine, and the ability to remove fluid and metabolic products decreases.
Hence the characteristic picture: protein and blood in the urine, edema due to fluid retention and loss of protein, increased pressure due to dysregulation and accumulation of waste with significant damage.
Basic forms
- Acute post-infectious glomerulonephritis - develops one to three weeks after streptococcal tonsillitis, scarlet fever or skin infection; more often in children, the prognosis is generally favorable
- IgA nephropathy is the most common form in the world; manifests itself as episodes of visible blood in the urine against the background or immediately after acute respiratory viral infection
- Rapidly progressive glomerulonephritis is a severe form with loss of kidney function over weeks; requires immediate treatment
- Membranous nephropathy and other forms with massive protein loss
- Glomerulonephritis in systemic diseases: lupus, vasculitis, hemorrhagic vasculitis
- Chronic glomerulonephritis - long-term course with a gradual decrease in kidney function
Symptoms
- Swelling, most noticeable in the morning on the face and eyelids, in the evening - on the legs
- Urine the color of meat slop, dark, reddish
- Decreased urine output
- Increased blood pressure
- Foamy urine is a sign of significant protein loss
- Headache, weakness, fatigue
- Dull pain or heaviness in the lower back
- Shortness of breath due to fluid retention
- Nausea, loss of appetite with increasing renal failure
- Possible asymptomatic course with changes only in tests - a common option in chronic forms
How is it different from pyelonephritis?
- Pyelonephritis is a bacterial infection of the renal pelvis and tissue; high fever, chills, side pain, white blood cells and bacteria in the urine; treated with antibiotics
- Glomerulonephritis is an immune inflammation of the glomeruli; edema, hypertension, protein and red blood cells in the urine; antibiotics don't treat it
- Pyelonephritis is often unilateral, glomerulonephritis always affects both kidneys
- In case of pyelonephritis, the leading role is played by urine culture, in case of glomerulonephritis - daily protein, immunological tests and biopsy
The practical significance of this difference is great: antibiotic treatment for glomerulonephritis does not help, and the lost time results in a decrease in kidney function.
Diagnostics
- General urine analysis with sediment microscopy - altered red blood cells and casts indicate glomerular origin of the blood
- Daily protein loss or urinary protein/creatinine ratio
- Creatinine with GFR calculation, urea, electrolytes
- Total protein and blood albumin, lipid profile
- Immunological studies: complement, antibodies in systemic diseases
- Antistreptolysin-O and throat culture for suspected post-infectious form
- Screening for hepatitis B and C, HIV
- Ultrasound of the kidneys - assessment of size and structure, exclusion of urological causes
- Kidney biopsy with histological examination is a key method: it determines the form of the disease and treatment tactics
- 24-hour blood pressure monitoring
Treatment
- Treatment is selected by a nephrologist depending on the form confirmed by biopsy
- Strict blood pressure control is a mandatory basis for any form of
- Drugs that reduce urinary protein loss
- Glucocorticoids and other immunosuppressive drugs for active forms
- Limiting salt and correcting the drinking regime for edema
- Diuretics for severe edema
- Lipid profile correction
- Sanitation of foci of infection, including treatment of tonsillitis
- Treatment of the main systemic disease in secondary forms
- Avoidance of non-steroidal anti-inflammatory drugs without prescription
- Renal replacement therapy for end-stage disease
Observation and lifestyle
- Regular monitoring of urine analysis, daily protein and creatinine
- Daily blood pressure measurement and diary keeping
- Weight monitoring as an indicator of fluid retention
- Limiting salt
- Moderate physical activity
- Quitting smoking
- Be careful with painkillers and dietary supplements
- Timely treatment of upper respiratory tract infections
- Vaccination as recommended by a doctor
- Consultation with a nephrologist when planning pregnancy
Where to get examined in Tashkent
Diagnosis requires extensive laboratory examination, ultrasound and, in most cases, a kidney biopsy with a full histological examination.
In Tashkent, a urological examination and kidney biopsy for suspected glomerulonephritis are carried out at the UROLOGIC COMPLEX medical center and at the Tashkent Medical Park clinic, and further treatment is prescribed and monitored by a nephrologist.
If protein or red blood cells are persistently detected in a urine test, do not limit yourself to taking the test again: you need to determine where they come from. It is at this stage that time is most often lost. Clinic contacts are below.
