| Chronic glomerulonephritis results when tufts of blood capillaries in the kidney (glomeruli) that filter waste and control fluid excretion gradually become unable to function properly. The specific cause is often unknown, but it seems to be followed by inflammation brought on by an immune response. The result is high blood pressure (hypertension) and chronic kidney failure (chronic renal failure). The kidneys play a pivotal role in balancing our blood pressure through a system of sensors and hormones.
Approximately 1 quart of blood passes through the glomeruli every minute (the equivalent of filtering all the body's plasma 60 times a day or about 47 gallons (99% of which a healthy kidney will return to the body). So as the glomeruli fail and waste products accumulate, it is not surprising that serious consequences follow. Typically, the kidneys shrink and become severely contracted. Fibrous and scar tissue eventually replaces functional kidney tissue. The rate of destruction varies between individuals, but often many years pass until the affected individual starts to experience the symptoms of chronic kidney (renal) failure (CRD) and end-stage renal disease (ESRD).
Chronic glomerulonephritis actually refers to a diverse category of diseases with varying causes. There are a number of different forms of glomerulonephritis, including acute glomerulonephritis, membranoproliferative glomerulonephritis, rapidly progressive glomerulonephritis, idiopathic membranous glomerulonephritis, and IgA nephropathy, any of which can progress to chronic glomerulonephritis.
The condition that most often leads to chronic glomerulonephritis and its progression toward chronic renal failure and end-stage renal disease is acute glomerulonephritis, which has many causes. Diseases that are risk factors for acute glomerulonephritis (which, as indicated, may progress to chronic glomerulonephritis) include syphilis, malaria, typhoid fever, mononucleosis, mumps, measles, and Henoch-Schönlein purpura. Chronic glomerulonephritis may also develop secondary to other diseases, including diabetes mellitus, systemic lupus erythematosus, hepatitis C, and acquired immunodeficiency syndrome (AIDS).Incidence and Prevalence: Chronic glomerulonephritis is rare and affects only 4 out of every 100,000 individuals. Twenty to fifty percent of individuals with acute glomerulonephritis will eventually develop chronic glomerulonephritis. Approximately 25% of individuals with chronic glomerulonephritis have no prior history of kidney disease, and in these cases, the disorder first appears as chronic renal failure. In the US, chronic glomerulonephritis is responsible for 10% of all patients on dialysis (Salifu). |
Source: Medical Disability Advisor
| History: Individuals with chronic glomerulonephritis may report a vague feeling of weakness or discomfort (malaise), increasing irritability and mental cloudiness, a metallic taste in the mouth, excretion of large amounts of urine (polyuria), excessive urination at night (nocturia), headache, dizziness, and digestive disturbances. If the disease has progressed, the individual may complain of breathing difficulties (dyspnea) and pain in the chest (angina). Physical exam: Examination may reveal weight loss, fluid retention (edema), and most often, high blood pressure (hypertension). It is not uncommon for the individual with chronic glomerulonephritis to have nosebleeds; signs of blocked arteries (arteriosclerosis); an enlarged heart (cardiomegaly); and bleeding (hemorrhage) into the kidneys, lungs, eye tissue (retina), and brain (cerebrum). Physical examination of the back (fundus) of the eye may reveal vessel changes and edema of the optic discs (papilledema). Tests: A laboratory test of the urine (urinalysis) should be done to determine its specific gravity and protein content and whether it contains white blood cells, kidney tubular cells, and hemoglobin. Blood tests should include a complete blood count (CBC) to test for low hemoglobin in the bloodstream (anemia). Ultrasound and CT scan may be used to visualize the kidneys. A small sample of tissue may be taken from the kidney (renal biopsy) for microscopic examination to verify diagnosis in those individuals who have no prior history of kidney disease. |
Source: Medical Disability Advisor
| The initial treatment for chronic glomerulonephritis should include therapy for the underlying disease that precipitated the condition. Symptoms that occur as a result of chronic glomerulonephritis itself may be treated using various drug therapies. Fluid retention (edema) and high blood pressure (hypertension) are treated with drugs that promote fluid loss (diuretics) and lower blood pressure (angiotensin converting enzyme [ACE] inhibitors). Other drug treatments may include anti-inflammatory drugs (corticosteroids), drugs that decrease the response of the immune system (immunosuppressive agents), and drugs that prevent clotting (anticoagulants or antiplatelet agents). Usually, dietary salt (sodium) and water will be restricted. Kidney dialysis or transplantation may become necessary if the individual begins to develop progressive renal failure leading to end-stage renal disease. |
Source: Medical Disability Advisor
| Chronic glomerulonephritis is a gradual (insidious) disease that develops over an extended period of time (often as long as 30 years). The treatment outcome is dependent upon the cause, the degree of impairment of kidney function at the time of diagnosis, and the severity of the high blood pressure (hypertension) and protein loss in the urine (proteinuria). Drug treatments may slow or stabilize this progression in some individuals. If left untreated, chronic glomerulonephritis will progress to irreversible end-stage renal failure. The individual will then develop massive infiltration of fluid into connective tissues of the body (anasarca) unless dialysis treatments are initiated. Very few individuals spontaneously survive this stage of the disease and enter remission. Without dialysis treatment or kidney transplantation, most individuals die within 2 years. |
Source: Medical Disability Advisor
| A primary complication of chronic glomerulonephritis is elevated blood pressure (hypertension). Other complications may include urinary tract or kidney infection (pyelonephritis), increased susceptibility to other infections, inflammation of the brain tissue (hypertensive encephalopathy), decreased pumping ability of the heart (congestive heart failure), and chronic kidney (renal) failure with progression to end-stage renal disease. |
Source: Medical Disability Advisor
| If kidney dialysis is required, individuals may require an extended leave of absence or a switch to a part-time or flex-time schedule to accommodate their treatment. Individuals receiving dialysis treatments should be assigned more sedentary duties. |
Source: Medical Disability Advisor
| If an individual fails to recover within the expected maximum duration period, the reader may wish to consider the following questions to better understand the specifics of an individual's medical case. Regarding diagnosis:
- Does individual have any risk factors?
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What symptoms does individual have?
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What were the findings on physical exam?
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Has individual received appropriate testing to establish the diagnosis?
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Have conditions with similar symptoms been ruled out?
Regarding treatment:
- Has the underlying condition responded to treatment?
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Has dialysis become necessary? Kidney transplant?
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Does individual follow dietary restrictions?
Regarding prognosis:
- Is individual's employer able to accommodate any necessary restrictions?
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Does individual have any complications?
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Source: Medical Disability Advisor
| Salifu, Moro O., and Barbara G. Delano. "Glomerulonephritis, Chronic." eMedicine. Eds. Frank C. Brosius, et al. 24 Jan. 2003. Medscape. 9 Oct. 2004 <http://emedicine.com/med/topic880.htm>. |
Source: Medical Disability Advisor
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