Glomerulonephritis (GN) is a serious kidney disorder that can lead to end-stage renal disease (ESRD), serious morbidity, or death. Worldwide, IgA Nephropathy (Berger disease) is the most common cause of GN. IgA nephropathy is an autoimmune disease and is one of the most common kidney diseases, other than those caused by diabetes or high blood pressure.

Glomerulonephritis represents 10-15% of glomerular diseases. GN comprises 25-30% of all cases of end-stage renal disease (ESRD).

What is glomerulonephritis?

Glomerulonephritis (GN), also known as nephrotic syndrome, is the term used to refer to several kidney diseases usually affecting both kidneys. Many of the diseases are characterized by inflammation either of the glomeruli or of the small blood vessels in the kidneys. Making them unfunctional in getting rid of wastes and extra fluid in the body, resulting in kidney failure.

These are a group of diseases categorized based on their pathological pattern, which is broadly grouped into non-proliferative (number of cells are not changed) or proliferative types (number of cells affecting increase) leading to ESRD.

Types of Glomerulonephritis

Based on the microscopic appearance Glomerulonephritidies are classified of the affected kidney tissue under the microscope. Each of these entities can be associated with high blood pressure, progressive kidney failure, edema, high cholesterol, and anemia.

The specific names of the various glomerulonephritis are

  • Focal and Segmental Glomerulosclerosis
  • Minimal Change Disease
  • Membranous Glomerulonephritis
  • Membranoproliferative Glomerulonephritis
  • IgA Nephropathy
  • Pauci-Immune Glomerulonephritis
  • Crescentic glomerulonephritis

What is IgA nephropathy?

IgA nephropathy, also known as Berger’s disease, is a proliferative pathology pattern that occurs when an antibody called immunoglobulin A (IgA) deposits build in kidneys. which results in local inflammation that, over time, hamper kidney’s ability to filter wastes from the body leading to ESRD.

Causes for Glomerulonephritis

Many conditions can cause glomerulonephritis. Sometimes the disease cause is unknown. Conditions that can lead to inflammation of the kidneys’ glomeruli include

Pathological causes

  • High blood pressure
  • Diabetic kidney disease (diabetic nephropathy)

Infections

  • Bacterial infections (Staphylococcus, Pneumococcus, or Streptococcus)
  • Fungal or Parasitic infections (like malaria)
  • Viral infections (Hepatitis B and Hepatitis C or HIV infections)
  • Vasculitis (blood vessel inflammation)
  • Cryoglobulinemia
  • Eosinophilic granulomatosis with polyangiitis
  • Granulomatosis with polyangiitis
  • Microscopic polyangiitis

Immune disorders

  • Goodpasture syndrome
  • The systemic lupus erythematosus (lupus)
  • IgA nephropathy

Other causes

  • Hereditary nephritis
  • Drugs (for example, quinine, gemcitabine, or mitomycin C).

Signs & Symptoms of Glomerulonephritis

The signs and symptoms of glomerulonephritis depend on the condition of Acute or Chronic. Urine analysis generally helps for diagnosing.

Sign and Symptoms of Glomerulonephritis include:

  • Hematuria – Pink or cola-colored urine from red blood cells in your urine ()
  • Proteinuria – Foamy urine due to excess protein ()
  • Hypertension – High blood pressure ()
  • Edema – Fluid retention. Swelling may be evident in the face, hands, feet, and abdomen.

Diagnosis

Generally, diagnosis starts with a urine examination followed by tests based on the signs & symptoms

  • Blood tests investigating the cause, including FBC, inflammatory markers, and special tests (including ASLO, ANCA, Anti-GBM, Complement levels, Antinuclear antibodies)
  • Biopsy of the kidney
  • Renal ultrasonography is useful for prognostic purposes in finding signs of chronic kidney disease, which however may be caused by many other diseases than glomerulonephritis. [3]

Treatment for Glomerulonephritis

The treatment of glomerulonephritis depends on the condition and severity

The main strategy in treating Glomerulonephritis involves managing blood pressure followed by reducing inflammation and stopping the destruction of filtering units.

Agents used to treat inflammation are anti-inflammatory agents like Corticosteroids, Cyclophosphamide, and other agents like Mycophenolate mofetil, Azathioprine, Cyclosporine, etc. and diuretics for reducing swelling or edema. [4]

Prevalence

  • Glomerulonephritis represents 10-15% of glomerular diseases. Variable incidence has been reported due in part to the subclinical nature of the disease in more than one half of the affected population.
  • Glomerulonephritis occupies the 3rd place among all renal diseases.
  • The prevalence is 10-15 per 10 000 adults. Last decades, the increase of glomerulonephritis prevalence was observed, which is due to the ecological situation and immune system changes.
  • A male-to-female ratio of 2:1 has been reported.
  • Most cases occur in patients aged 5-15 years. Only 10% occur in patients older than 40 years. However acute nephritis may occur at any age, including infancy.
  • IgA nephropathy – very common in many countries (20-25% of all glomerulonephritis in Southern Europe and Australia and 30-40% in Japan and Singapore). [5][6]

Clinical Trials on Glomerulonephritis worldwide

Total Studies

A total of 415 clinical trials were registered on Glomerulonephritis all around the world with major studies in the United States (145), China (93), France (46), and Canada (34)

Ongoing studies

A total of 105 studies are On-going in Glomerulonephritis with major studies in the United States (48), China (22), France (23), and Canada (15)

(Data as on Sep-2020)


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References

  1. https://www.mayoclinic.org/diseases-conditions/glomerulonephritis/symptoms-causes/syc-20355705
  2. https://emedicine.medscape.com/article/239278-overview#a5
  3. https://www.nhs.uk/conditions/glomerulonephritis/treatment/
  4. https://www.hopkinsmedicine.org/nephrology/glomerulonephritis.html
  5. https://emedicine.medscape.com/article/239278-overview#a5
  6. http://www.1spbgmu.ru/images/home/universitet/Struktura/Kafedry/Kafedra_terapii_gospitalnoy/methodic_in_eng/Glomerulonephritis_eng.pdf
  7. https://www.myvmc.com/diseases/glomerulonephritis-gn/
  8. https://www.scribd.com/doc/27859727/Epidemiology-Glomerulonephritis-Represents-10-15-of-Glomerular-Diseases