More than one million kidney bodies (glomeruli) are responsible in each kidney to filter out about 180 liters of primary urine per day from the liter of blood that flows through them per minute, from which just under 2 liters of final urine together with metabolic waste products are concentrated. In addition to detoxification, the kidney is important for the regulation of water and salt balance, blood pressure regulation, formation of red blood cells and bone metabolism. Inflammatory processes can massively affect the entire kidney function.
What is glomerulonephritis?
Glomerulonephritis refers to an inflammation of the kidney tissue, which affects both kidneys and initially runs on the kidney corpus, but can also spread to the rest of the kidney tissue. It can be short and severe (acute glomerulonephritis), rapidly progressive (rapid progressive) or slow and gradual (chronic glomerulonephritis).
Mostly the immune system is involved. It is suspected that the constant contact of the vascular bundles in the kidney corpuscles with the pollutants in the blood leads to an inflammatory reaction - why this is the case in some people, not in others, is so far largely unclear. However, scientists assume that genetic factors play a role.
Which forms are there?
Due to the variety of different forms of inflammation, the disease is very diverse and can only be assessed by the kidney specialist. It is important to distinguish the forms from each other, because they are different and treated differently and also differ in their prognosis. The division can be made on the basis of the symptoms, the causes, the mechanism of origin and the type of tissue changes, the technical name of the individual forms usually depends on the course and location of primary damage (eg extracapillary or membranous glomerulonephritis).
- One criterion is how the immune system is involved. In a large group, immune complexes are formed, that is, compounds of antigens and antibodies. These can arise as a result of other diseases (eg after strep throat strep throat) by antibodies formed against bacterial antigens, which initially circulate in the blood and then deposit at various sites of the renal corpuscles and damage them. In other forms, the organism forms autoantibodies against the inner layer of the renal corpuscles that deposit there. But other cells of the immune system (eg T cells, complement) can trigger inflammatory reactions.
- Another distinguishing feature is whether the inflammation initially occurs only at the kidney (primary form) or occurs in the context of systemic diseases that affects other organs (eg the connective tissue in collagenosis or the lung in Goodpasture syndrome), cancers, infections or in certain medications (secondary form).
Symptoms and diagnostics
Whether, how and when the disease manifests depends on the type of inflammation. In many cases, sufferers feel no complaints for a long time, even though the damage to the kidney is already happening. Later, the symptoms of progressive renal failure, such as decreased performance and malaise, loss of appetite, fluid retention, cardiac arrhythmia and high blood pressure, but also nausea, bad breath, itching and yellowish skin discoloration.
It can lead to bone softening, increased susceptibility to infection, anemia, difficulty concentrating and headache. Some patients also complain of kidney pain. In the urine, blood, protein and so-called urinary cylinders, in the blood altered kidney values (creatinine) can be detected. Other examinations include kidney ultrasound and renal function tests.
The diagnosis and allocation of the inflammatory form ultimately requires the removal of tissue samples from the kidney. In order to be able to make a diagnosis as early as possible and to be able to start therapy, it is important to carry out urine tests in potential risk groups. Thus, urine control should be performed 1-3 weeks after streptococcal strep throat. Also in systemic diseases that can lead to a secondary G., should be searched at regular intervals for blood and protein in the urine.
Therapy and treatment
The therapy depends on the type of inflammation. If there is an underlying disease, it will be treated, eg tonsillitis with antibiotics. Otherwise, antihypertensive drugs, cortisone and immunosuppressants are available. Depending on the extent of the kidney failure, the affected person must undergo a "blood wash" (dialysis) and change his diet and hydration.
The course varies from forms with spontaneous recovery, to those with inconsequential cure in early therapy, to forms in which a renal failure requiring dialysis occurs within 5 years or even a few months.