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Glomerulonephritis

Inflammation of the glomeruli. Most often, it is caused by an autoimmune disease, but it can also result from infection.

PubMed Health Glossary
(Source: NIH - National Institute of Diabetes and Digestive and Kidney Diseases)

About Glomerulonephritis

Many diseases affect kidney function by attacking the glomeruli, the tiny units within the kidney where blood is cleaned. Glomerular diseases include many conditions with a variety of genetic and environmental causes, but they fall into two major categories:

Although glomerulonephritis and glomerulosclerosis have different causes, they can both lead to kidney failure.

How do glomerular diseases interfere with kidney function?

Glomerular diseases damage the glomeruli, letting protein and sometimes red blood cells leak into the urine. Sometimes a glomerular disease also interferes with the clearance of waste products by the kidney, so they begin to build up in the blood. Furthermore, loss of blood proteins like albumin in the urine can result in a fall in their level in the bloodstream. In normal blood, albumin acts like a sponge, drawing extra fluid from the body into the bloodstream, where it remains until the kidneys remove it. But when albumin leaks into the urine, the blood loses its capacity to absorb extra fluid from the body. Fluid can accumulate outside the circulatory system in the face, hands, feet, or ankles and cause swelling... Read more about glomerular diseases NIH - National Institute of Diabetes and Digestive and Kidney Diseases

What works? Research summarized

Evidence reviews

Immunosuppressive agents for treating IgA nephropathy

IgA nephropathy is a common kidney disease that often leads to decreased kidney function and may result ultimately in kidney failure for one‐third of affected people. The cause of IgA nephropathy is not known, although most people with the disease have abnormalities in their immune system. We identified 32 studies enrolling 1781 patients that met our inclusion criteria. This review found that if people with IgA nephropathy receive immunosuppressive drugs, particularly steroids, they may be less likely to develop kidney failure needing dialysis or transplantation. Few studies were available and the harms of therapy are currently not well understood. Larger placebo‐controlled studies are now needed to be certain about the benefits and hazards of steroids on outcomes in IgA nephropathy and to identify which specific patients might benefit most from the treatment.

Interventions for renal vasculitis in adults

Renal vasculitis presents as rapidly progressive glomerulonephritis which is a form of kidney disease that causes damage to the small structures (glomeruli) inside the kidneys that help filter waste and fluids from blood to form urine. The disease leads to a rapid loss of kidney function. Standard suppression of the immune system with steroids and cyclophosphamide is recommended. The aim of this review was to evaluate the benefits and harms of any intervention for the treatment of renal vasculitis. Thirty one studies (2217 patients) were identified. Plasma exchange reduces the risk of end‐stage kidney disease in patients presenting with severe acute kidney failure. The use of pulse cyclophosphamide results in good remission rates but there was an increased risk of relapse. Azathioprine is effective as maintenance therapy once remission has been achieved. Mycophenolate mofetil is equivalent for remission induction than cyclophosphamide. Mycophenolate mofetil has also been tested in maintenance treatment and was found to result in a higher rate of disease relapse. Initial data on rituximab showed equivalent effectiveness to cyclophosphamide. Methotrexate and leflunomide are useful in maintenance therapy but their relative effectiveness are not clearly defined. Treatment with co‐trimoxazole may prevent respiratory infections and relapses but are unlikely to have a major impact on systemic relapses of vasculitis.

Immunosuppressive treatment for idiopathic membranous nephropathy in adults with nephrotic syndrome

Idiopathic membranous nephropathy (IMN) is a disease in which glomerular basement membrane becomes thickening by light microscopy on renal biopsy and it represents a major cause of primary nephrotic syndrome in adults. A combined alkylating agent and corticosteroid regimen had short‐ and long‐term benefits on adult IMN with nephrotic syndrome. Among alkylating agents, cyclophosphamide was safer than chlorambucil. It should be emphasised that the number of included randomised studies with high‐quality design was relatively small and most of the included studies did not have adequate follow‐up and enough power to assess the prespecified outcomes. Meanwhile, this regimen was significantly associated with more withdrawals or hospitalisations. Although a six‐month course of alternating monthly cycles of corticosteroids and cyclophosphamide was recommended by the KDIGO Clinical Practice Guideline 2012 as the initial therapy for adult IMN with nephrotic syndrome, clinicians should inform their patients of the lack of high‐quality evidence for these benefits as well as the well‐recognised adverse effects of this therapy. Whether this combined therapy should be indicated in all adult patients at high risk of progression to ESKD or only restricted to those with deteriorating kidney function still remained unclear.

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Summaries for consumers

Immunosuppressive agents for treating IgA nephropathy

IgA nephropathy is a common kidney disease that often leads to decreased kidney function and may result ultimately in kidney failure for one‐third of affected people. The cause of IgA nephropathy is not known, although most people with the disease have abnormalities in their immune system. We identified 32 studies enrolling 1781 patients that met our inclusion criteria. This review found that if people with IgA nephropathy receive immunosuppressive drugs, particularly steroids, they may be less likely to develop kidney failure needing dialysis or transplantation. Few studies were available and the harms of therapy are currently not well understood. Larger placebo‐controlled studies are now needed to be certain about the benefits and hazards of steroids on outcomes in IgA nephropathy and to identify which specific patients might benefit most from the treatment.

Interventions for renal vasculitis in adults

Renal vasculitis presents as rapidly progressive glomerulonephritis which is a form of kidney disease that causes damage to the small structures (glomeruli) inside the kidneys that help filter waste and fluids from blood to form urine. The disease leads to a rapid loss of kidney function. Standard suppression of the immune system with steroids and cyclophosphamide is recommended. The aim of this review was to evaluate the benefits and harms of any intervention for the treatment of renal vasculitis. Thirty one studies (2217 patients) were identified. Plasma exchange reduces the risk of end‐stage kidney disease in patients presenting with severe acute kidney failure. The use of pulse cyclophosphamide results in good remission rates but there was an increased risk of relapse. Azathioprine is effective as maintenance therapy once remission has been achieved. Mycophenolate mofetil is equivalent for remission induction than cyclophosphamide. Mycophenolate mofetil has also been tested in maintenance treatment and was found to result in a higher rate of disease relapse. Initial data on rituximab showed equivalent effectiveness to cyclophosphamide. Methotrexate and leflunomide are useful in maintenance therapy but their relative effectiveness are not clearly defined. Treatment with co‐trimoxazole may prevent respiratory infections and relapses but are unlikely to have a major impact on systemic relapses of vasculitis.

Immunosuppressive treatment for idiopathic membranous nephropathy in adults with nephrotic syndrome

Idiopathic membranous nephropathy (IMN) is a disease in which glomerular basement membrane becomes thickening by light microscopy on renal biopsy and it represents a major cause of primary nephrotic syndrome in adults. A combined alkylating agent and corticosteroid regimen had short‐ and long‐term benefits on adult IMN with nephrotic syndrome. Among alkylating agents, cyclophosphamide was safer than chlorambucil. It should be emphasised that the number of included randomised studies with high‐quality design was relatively small and most of the included studies did not have adequate follow‐up and enough power to assess the prespecified outcomes. Meanwhile, this regimen was significantly associated with more withdrawals or hospitalisations. Although a six‐month course of alternating monthly cycles of corticosteroids and cyclophosphamide was recommended by the KDIGO Clinical Practice Guideline 2012 as the initial therapy for adult IMN with nephrotic syndrome, clinicians should inform their patients of the lack of high‐quality evidence for these benefits as well as the well‐recognised adverse effects of this therapy. Whether this combined therapy should be indicated in all adult patients at high risk of progression to ESKD or only restricted to those with deteriorating kidney function still remained unclear.

See all (9)

Terms to know

Autoimmune Disease
Disease that results when the immune system mistakenly attacks the body's own tissues. Examples include multiple sclerosis, type 1 diabetes, rheumatoid arthritis, and systemic lupus erythematosus.
Glomerular Filtration Rate
The rate at which the kidneys filter wastes and extra fluid from the blood, measured in milliliters per minute.
Glomeruli
A tiny set of looping blood vessels in the nephron where blood is filtered in the kidney. Plural of glomerulus.
Glomerulosclerosis
Scarring of the glomeruli. It may result from diabetes (diabetic glomerulosclerosis) or from deposits in parts of the glomeruli (focal segmental glomerulosclerosis). The most common signs of glomerulosclerosis are proteinuria and chronic kidney disease.
Nephrons
A tiny part of the kidneys. Each kidney is made up of about 1 million nephrons, which are the working units of the kidneys, removing wastes and extra fluids from the blood.
Nephrotic Syndrome
A collection of symptoms that indicate kidney damage. Symptoms include high levels of protein in the urine, lack of protein in the blood, and high blood cholesterol.

More about Glomerulonephritis

Photo of an adult

Also called: GN

Other terms to know: See all 6
Autoimmune Disease, Glomerular Filtration Rate, Glomeruli

Related articles:
How the Kidneys Work

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