What are the other Names for this Condition? (Also known as/Synonyms)

• Chronic Glomerular Nephritis
• Chronic GN
• Glomerulonephritis, Chronic Type

What is Chronic Glomerulonephritis? (Definition/Background Information)

• Chronic Glomerulonephritis (or Chronic GN) is a collection of kidney diseases in which the glomeruli, round clusters of capillaries found in the cortex of the kidney that function in removing waste to be excreted as urine, become progressively damaged with time
• As the name suggest, Chronic Glomerulonephritis is a longstanding condition. It is one of the top causes of chronic kidney failure as well as end-stage kidney/renal disease
• The risk factors for the condition include family history of the disease, prior episodes of acute glomerulonephritis, bacterial or viral infections, and certain autoimmune disorders
• In some individuals, the cause of Chronic Glomerulonephritis is unknown; while in others, it may be due to factors such as high blood pressure, diabetic kidney disease, and IgA nephropathy
• The common signs and symptoms of Chronic Glomerulonephritis are frequent urination, with blood or foam present in the urine. Muscle aches, fatigue, and loss of appetite frequently accompany this disease. Complications of the condition include urinary tract infection, nephrotic syndrome, and chronic renal failure
• Treatment of Chronic Glomerulonephritis depends on the underlying cause. In many individuals, the treatment focuses on alleviating the symptoms of the disease and lowering high blood pressure. Diuretic pills are often prescribed for the condition
• There is no cure for Chronic Glomerulonephritis, which can be a life-threatening illness. However, the prognosis for Chronic GN may be improved with an accurate diagnosis and early treatment

There are 2 main types of glomerulonephritis that include:

• Acute Glomerulonephritis: The signs and symptoms of this form of GN develop suddenly
• Chronic Glomerulonephritis: The signs and symptoms of this form of GN develop gradually

Who gets Chronic Glomerulonephritis? (Age and Sex Distribution)

• Chronic Glomerulonephritis can occur in individuals of all age groups
• Both males and females can be affected and no particular preference is noted
• The condition can occur across all races and ethnicities

What are the Risk Factors for Chronic Glomerulonephritis? (Predisposing Factors)

The risk factors for Chronic Glomerulonephritis may include:

• It is known to occur in some families in a higher frequency, which may suggest a genetic involvement
• Individuals with Alport syndrome: Some studies have shown that there is an increased incidence of Chronic Glomerulonephritis in young males who have poor vision and poor hearing due to Alport syndrome. Such individuals are thought to have a genetic predisposition to the condition (hereditary nephritis)
• Individuals having episodes  of acute glomerulonephritis may develop the chronic form without adequate treatment, as time progresses
• Vasculitis, which is an abnormal inflammation of the arteries, such as caused by Wegener granulomatosis and polyarteritis nodosa
• Smoking for a prolonged period (often many years)
• Exposure to hydrocarbon solvents such as paints, fuels (gasoline, petroleum products), vehicular exhaust, glues and adhesives, organic solvent vapors, some aerosols and pesticides, can increase the risk. Hence, individuals with occupations that involve painting, printing, vehicle maintenance and repair, fabrication, firefighting, organic chemical and pharmaceutical processes, continuous exposure to motor exhausts, are at risk for this kidney disease
• History of cancer: Cancer can affect the functioning of multiple organs including the kidneys
• Autoimmune disorders such as Goodpasture syndrome and systemic lupus erythematosus
• Uncontrolled and longstanding diabetes
• Infections, such as caused by bacteria or virus, are known to increase the risk for Chronic GN
  • Bacterial infections may include bacterial endocarditis (bacterial infection of the heart) and post-streptococcal infection
  • Viral infections may include HIV, hepatitis B and C infections, etc.

It is important to note that having a risk factor does not mean that one will get the condition. A risk factor increases ones chances of getting a condition compared to an individual without the risk factors. Some risk factors are more important than others.

Also, not having a risk factor does not mean that an individual will not get the condition. It is always important to discuss the effect of risk factors with your healthcare provider.

What are the Causes of Chronic Glomerulonephritis? (Etiology)

Chronic Glomerulonephritis may be caused by a variety of factors and some of these include:

• Diabetic kidney disease: Uncontrolled diabetes may lead to greater damage of the kidneys as a result of complications
• Focal segmental glomerulosclerosis (FSGS): The scarring of the kidney tissue affects its function and results in nephrotic syndrome
• IgA nephropathy: A condition in which IgA antibodies accumulate in kidney tissue resulting in tissue damage
• Systemic lupus erythematosus (SLE or lupus): Autoantibodies found in SLE can attack the kidney tissues and damage its function
• Individuals with several episodes of acute glomerulonephritis may develop Chronic Glomerulonephritis with time
• The disease may have a genetic component, since it has been shown to occur in higher frequency in some families
• Abnormal immune system may lead to Chronic GN: Abnormal immunity can result in kidney tissue damage via a variety of mechanisms
• Uncontrolled high blood pressure may damage the kidneys, which over a period of time can cause this form of chronic kidney disease

In about 1 in 4 cases, the cause of Chronic Glomerulonephritis may remain unknown.

What are the Signs and Symptoms of Chronic Glomerulonephritis?

Many individuals with Chronic Glomerulonephritis may not be aware that they have the condition, since it does not cause significant signs and symptoms early in the disease.

The following are the common signs and symptoms of Chronic Glomerulonephritis:

• Excessive urination
• Presence of blood in urine
• Foamy urine: The individual can observe frothy urine while urinating
• High blood pressure or hypertension
• Frequent episodes of nosebleeds
• Getting easily tired, muscle aches and muscle cramps that worsen at night
• Signs and symptoms of anemia that include pale skin, fatigue, and dizziness
• Loss of appetite and weight loss
• Dry skin, with or without itching
• Difficulty in sleeping
• Nausea, vomiting, and diarrhea; feeling of abdominal bloating
• Shortness of breath and cough

In advanced cases, there may be neurological symptoms such as:

• Decreased alertness
• Drowsiness, lethargy
• Delirium
• Confusion

How is Chronic Glomerulonephritis Diagnosed?

A diagnosis of Chronic Glomerulonephritis may involve:

• A complete medical history
• A thorough physical examination
• Blood tests such as the following:
  • Complete blood count (CBC)
  • Blood glucose levels and hemoglobin A1c
  • Creatinine clearance blood test
  • Blood urea nitrogen (BUN) and creatinine levels
• Special blood tests to detect abnormal immune functions such as autoantibodies and complement level testing
• 24-hour urine protein analysis: There may be increased blood and/or increased protein in urine
• Chest X-ray
• Ultrasound scan of the kidneys
• CT and MRI scan of the abdomen
• Intravenous pyelogram (IVP): A series of X-rays using contrast dyes to detect abnormalities in the kidneys
• Kidney biopsy:
  • A biopsy of the kidney is performed and sent to a laboratory for a pathological examination. A pathologist examines the biopsy under a microscope. After putting together clinical findings, special studies on tissues (if needed) and with microscope findings, the pathologist arrives at a definitive diagnosis. Examination of the biopsy under a microscope by a pathologist is considered to be gold standard in arriving at a conclusive diagnosis
  • Biopsy specimens are studied initially using Hematoxylin and Eosin staining. The pathologist then decides on additional studies depending on the clinical situation
  • Sometimes, the pathologist may perform special studies, which may include immunohistochemical stains, molecular testing, and electron microscopic studies, to assist in the diagnosis

Many clinical conditions may have similar signs and symptoms. Your healthcare provider may perform additional tests to rule out other clinical conditions to arrive at a definitive diagnosis.

What are the possible Complications of Chronic Glomerulonephritis?

Individuals with Chronic Glomerulonephritis may experience certain complications that include the following:

• Chronic urinary tract infections and increased risk of other bacterial or viral infections
• Congestive heart failure
• Uncontrolled blood pressure
• Nephrotic syndrome:
  • Damage to the kidneys can lead to increased protein loss through urine. Excessive protein loss during urination results in decreased amounts of protein in circulating blood
  • Since protein in blood is important in maintaining fluid balance, the decreased protein in blood leads to abnormal fluid accumulation in the body (a condition termed as ‘edema’)
  • The fluid can accumulate in the face (facial edema), in the abdomen (ascites), or in the lower portions of the legs/feet (pedal edema)
  • Corticosteroid therapy may result in side effects such as frequent infections, brittle bones, hormonal imbalance, abnormal blood sugar, and cataracts
  • Longstanding Chronic GN can lead to chronic renal failure: Longstanding renal/kidney failure can result in end-stage renal/kidney disease (ESRD or ESKD). Individuals with end-stage renal disease require dialysis treatment or a kidney transplant

How is Chronic Glomerulonephritis Treated?

There is currently no cure for Chronic Glomerulonephritis. The treatment varies from one individual to another; it also depends on the cause of the underlying illness. Most treatment measures focus on controlling the symptoms of the disease.

• Often, lowering high blood pressure becomes a priority in the treatment of glomerulonephritis, which is accomplished through the use of drugs, as well as dietary changes focused on reducing the intake of sodium and potassium
• Maintaining fluid and electrolyte balance
• Maintaining adequate amounts of protein in the body
• Controlling diabetes using various treatment methods
• Individuals are often instructed to take diuretic pills, which treat puffiness and swelling associated with the disease
• If the cause of Chronic GN is due to an autoimmune disorder, then plasmapheresis to decrease the level of damaging autoantibodies may be considered
• If it is caused by abnormalities in the immune system, corticosteroids and other immunosuppressive drugs may be administered
• If the damage sustained by the kidney is severe resulting in ESRD, individuals may need regular urinary dialysis or may even have to undergo a kidney transplant
• Participating in support groups can help in better understanding of the condition and decreasing some of the stress factors

How can Chronic Glomerulonephritis be Prevented?

Currently, there is not enough understanding on the causes of Chronic Glomerulonephritis to provide concrete recommendations on preventing the condition. Also, in a majority of cases, the Chronic GN cannot be prevented.

Nevertheless, a few preventative suggestions include:

• Avoiding exposure to toxic substances, including mercury, organic solvents, and non-steroidal anti-inflammatory analgesics (NSAIDs, which include aspirin, naproxen, and ibuprofen)
• Since some viral infections can increase the risk for Chronic GN, and so, any risky behavior, such as not practicing safe sex or intravenous drug abuse, should be avoided
• Controlling blood pressure through medication and stress-relievers
• Controlling autoimmune disorders
• Keeping diabetes under control
• Adequate control of diabetes through medications and lifestyle modification
• Maintaining a healthy body weight
• Avoiding or reducing smoking
• Maintain basic hygiene; wash hands regularly

The US National Kidney Foundation provides some basic guidelines towards reducing the risk for Chronic Glomerulonephritis such as by certain avoiding risk behavior (including unsafe sex and consuming illicit drugs intravenously through sharing needles). This can help prevent infections (hepatitis infections and HIV/AIDS) that contribute to glomerulonephritis development.

What is the Prognosis of Chronic Glomerulonephritis? (Outcomes/Resolutions)

• The prognosis of Chronic Glomerulonephritis depends on the severity of the signs and symptoms. In general, this kidney disease can be a life-threatening disorder, since it can cause irreversible kidney damage over time
• Individuals with more severe signs and symptoms may have poorer prognosis than those who have milder presentations
• Individuals who respond to treatment have better prognosis than those who do not respond favorably to treatment
• Individuals who develop nephrotic syndrome may have poorer prognosis
• Individuals in whom Chronic GN progresses to end-stage renal disease may have guarded prognosis

Additional and Relevant Useful Information for Chronic Glomerulonephritis:

Acute glomerulonephritis is the sudden swelling of small regions in the kidney known as glomeruli, which are responsible for filtering blood. It prevents the body from removing excess fluid and waste products through urine.