Glomerulonephritis

Glomerulonephritis

The term “glomerulonephritis” encompasses various kidney diseases in which the filter particles (glomerula) in the kidney become inflamed. Each kidney has about one to two million of these tiny blood vessels. They are responsible for filtering the blood and producing the primary urine. In glomerulonephritis, this function is limited; if it is more severe, the amount of urine also decreases.

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• What are the causes of glomerulonephritis?
• What are the symptoms?
• How is the diagnosis made?
• How is glomerulonephritis treated?
• What can I do myself?
• Whom can I ask?
• How are the costs going to be covered?

What are the causes of glomerulonephritis?

There are many causes of glomerulonephritis. If they are unknown, one speaks of primary glomerulonephritis. Secondary glomerulonephritis occurs when it occurs as part of other diseases, especially:

• Autoimmune diseases (e.g. collagenosis, Wegener's granulomatosis, lupus erythematosus): Antibodies are directed against components of the glomerulus.
• Deposition of immune complexes in the smallest blood vessels of the glomeruli: These immune complexes consist of antibodies and structures dissolved in the blood against which these antibodies are directed.
• Infections: Immune reactions in connection with infections caused by bacteria (especially streptococci, staphylococci) or viruses (eg hepatitis B or hepatitis C).
• Tumor diseases.

Glomerulonephritis can be divided into further sub-forms depending on the cause or mechanism of development, the type of tissue change and the involvement of the immune system. This classification enables a more precise diagnosis and an adequate therapy finding.

What are the symptoms?

In the case of glomerulonephritis, the blood can no longer be appropriately purified; if it is more severe, the amount of urine also decreases. The blood vessels become leaky, causing an increased excretion of protein (proteinuria) and red blood cells (hematuria). As a result, this can lead to a lack of albumin or proteins in general and thus to the so-called nephrotic syndrome. This is characterized by greatly increased protein excretion in the urine (several g / day), massive protein deficiency, leg swelling, increased blood lipid levels and sometimes shortness of breath. High blood pressure is also common. Glomerulonephritis can lead to the development of kidney failure and even end-stage renal failure. This means the permanent failure of kidney function,which makes the initiation of renal replacement therapy necessary.

Glomerulonephritis can take an acute or chronic course. Depending on the form, kidney tissue is destroyed more or less quickly, which can ultimately lead to chronic kidney failure.

• Acute glomerulonephritis: It is triggered by an acute inflammation of the glomeruli. This can occur after infections as well as in the context of certain diseases (e.g. vasculitis, lupus erythematosus) or immune-related inflammatory processes of the kidneys. Glomerulonephritis is characterized by the excretion of protein and often small amounts of blood in the urine. In addition, high blood pressure and edema, general tiredness, fever and pain in the kidney region can develop. With very high protein excretion in the urine (several grams / day), there is a massive protein deficiency, leg swelling, increased blood lipid levels and sometimes shortness of breath ("nephrotic syndrome"). If acute glomerulonephritis leaves irreversible structural damage in the organ, it can lead to end-stage renal disease.
• Chronic glomerulonephritis: The disease begins insidiously and often causes hardly any symptoms for years or decades. Only increased blood pressure occurs frequently. Small amounts of protein and traces of blood are usually found in the urine as the first indications of the disease. In the further course, the blood values of the urinary substances also rise.

Over time, symptoms of progressive kidney failure show up, such as:

• Decline in performance and malaise,
• Loss of appetite,
• Nausea,
• Bad breath,
• Edema,
• Cardiac arrhythmias,
• High blood pressure,
• yellowish discoloration of the skin.

Chronic glomerulonephritis is usually no longer curable. The main aim of treatment is to control the kidney-related high blood pressure and to support the kidneys in their excretory function.

How is the diagnosis made?

Laboratory examinations play a central role in the diagnosis, especially:

• Urine: blood and protein, urine sediment, creatinine clearance;
• Blood: complement (CH50, C3 / C3c, C4), inflammation diagnostics, immune complexes, antibodies and autoantibodies (ANCA, ANA etc.), kidney function parameters such as creatinine, urea, uric acid etc.;

Note An examination of kidney tissue (biopsy) and, in certain cases, an ultrasound is often required.

How is glomerulonephritis treated?

Treatment for glomerulonephritis will vary depending on the form and cause. Medicines are used, for example to lower blood pressure, reduce inflammation or immunosuppression.

The course varies from forms with spontaneous recovery through those with inconsequential healing with early therapy to forms in which advanced kidney failure occurs within a few months to years. Dialysis or a kidney transplant is required in these cases.

What can I do myself?

Every patient can make a significant contribution to positively influencing the progression of chronic kidney disease.

• Kidney-friendly diet: The diet should be low in: table salt, protein (maximum 0.6-0.8 grams of protein per kilogram of body weight), fat, phosphate, potassium;
• Do not smoke;
• Low alcohol consumption;
• Regular exercise (no strenuous exercise that increases blood pressure);
• Avoidance of drugs that could potentially damage the kidneys;
• Regular check-ups;
• Compliance with treatment recommendations;
• Consult a doctor in the event of deterioration.

Whom can I ask?

The following are responsible for the treatment of glomerulonephritis:

• Specialist in internal medicine,
• Specialist in internal medicine and nephrology.

How are the costs going to be covered?

The costs for the diagnosis and treatment of glomerulonephritis are covered by the social security authorities. Your doctor will generally settle accounts directly with your health insurance provider. However, you may have to pay a deductible with certain health insurance providers (BVAEB, SVS, SVS, BVAEB).

Only if a doctor of choice is used (ie doctor without a health insurance contract) the costs will not be charged directly. In this case, you pay the resulting amount directly to the doctor and submit the invoice to your health insurance provider. You will be reimbursed a maximum of 80 percent of the tariff that a contract doctor or a contract outpatient clinic charges the health insurance provider.

Hospitalization

If a hospital stay is necessary because of glomerulonephritis, the hospital costs will be invoiced. The patient has to pay a daily contribution to the costs. Further medication treatment at home takes place by prescription from the general practitioner or specialist.

For more information, see What does a hospital stay cost?