Inflammation of the kidneys is called Nephritis. The inflammation may be limited to Glomeruli or to Interstitium. If it is limited to or predominantly involves glomeruli then it is called Glomerulo-nephritis. If it is limited to or predominantly involves tubules and tissues binding the nephrons (interstitium) then it is called Intersititial-nephritis.
Both types of nephritis (Nephritidis) almost always involve both kidnyes. When such inflammation occurs, the kidneys fail to function properly. In extreme cases, especially when the inflammation is of recent onset and is virulent, the kidneys may completely shut down. It is then called ACUTE NEPHRITIS. When kidneys fails rapidly due to acute nephritis then it is called ACUTE RENAL FAILURE. Patients with Acute renal failure due to acute nephritis are usually very ill with multiple symptoms.
When the inflammation is of mild but progressive in nature, it is then called chronic nephritis and the kidneys fail insidiously causing CHRONIC RENAL FAILURE. Patients with chronic renal failure, during initial stages (ranging from few moths to years) may not experience any symptoms and may be unaware of the condition. Most of the time chronic renal failure is recognized on routine blood and urine tests done during physical examination or during monitoring of other medical conditions. When chronic renal failure progresses, patient will ultimately loose the kidney function to an extent that he or she will not be able to live without artificial kidney treatment (Dialysis). Such patients are said to be in End Stage Renal Disease (ESRD) where 'End Stage' refers to the kidney not patient's life!
Some
of the symptoms of
Nephritis:
1. Tiredness,
weakness and generalized feeling of not being
well
2. Decrease in urine volume, usually in Acute Nephritis
3. Increase in urine volume, increased frequency of urination (polyuria),
increased night-time urination
(nocturia) usually in chronic nephritis
4. Cloudy/frothy or dark urine
5. Visible Blood in urine (Hematuria)
6. Blood visible in the urine only when tested or examined under microscope (Microhematuria)
7. Proteinuria
8. Swelling of face and legs (Edema)
9. Difficulty in breathing (Dyspnea)
10.
Other symptoms depend on the cause of nephritis and its severity
1. As described under the treatment of acute renal failure
2. As described under the treatment of acute glomerulo nephritis
3. Other measures depend on the cause of nephritis
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CAUSES OF ACUTE GLOMERULO-NEPHRITIS:
Acute glomerulo nephritis is almost always caused by our immune response to known and unknown stimuli.
KNOWN STIMULI:
Various infective diseases including (but not limited to):
Strep sore throat
Bacterial skin infection
Pneumonia
Viral infections
Parasitic infections
Malaria
Rocky Mountain Spotted Fever
Almost
any infection
Various Disorders of Immune system:
Lupus
Sjogrens syndrome
UNKNOWN STIMULI: ????
SYMPTOMS OF ACUTE GLOMERULO-NEPHRITIS:
Symptoms of Acute Glomeruo-nephritis are for the most part same as those
listed under Acute
Renal Failure.
TREATMENT OF ACUTE GLOMERULO-NEPHRITIS:
1. As described under the treatment
of acute renal failure.
2. Additional measures depending upon the cause of the acute glomerulo-nephritis
3. At times patients immune system may need to be suppressed with one or more of
the
following medications:
Prednisone
Imuran
Cytoxan (Cyclophosphamide)
Cyclosporin (Neoral, Sandimmune)
Chlorambucil
4. On occasion the offending immune agent need to be removed from the blood through
a process called 'Plasma-pheresis'
When the inflammation of the glomeruli occur slowly over a period of several years it is
called chronic glomerulo-nephritis. Not all, but many such chronic
glomerulo-nephritis will ultimately cause chronic renal failure. Some of them could be the
result of a systemic disease (like lupus) and others may be result of the primary disease
of the kidney with the absence of any systemic disorder. As in acute glomerulo-nephritis,
almost all of the primary chronic glomerulo-nephritis are the result of body's immune
reactions that went wrong.
Some of the types of Chronic Glomerulo-nephritis are:
1. Minimal Change Glomerulo-Nephritis (MCGN)
2. Membranous glomerulo-nephritis (MGN)
3. Membrano-Prolifierative Glomerulo Nephritis (MPGN)
4.
Focal Segmental Glomerulo-Sclerosis (FGS OR FSGS)
5. IgA Nephropathy
6. Fibrillary Glomerulo-Nephritis
7. Thin membrane disease
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ACUTE AND CHRONIC
INTERSTITIAL NEPHRITIS:
When the inflammation occurs predominantly in the interstitial tissue (interstitium) it is
called Interstitial Nephritis. This could happen suddenly as an acute event (Acute
Interstitial Nephritis); or, could happen over an extended period of time to slowly
progress to become diagnosable (Chronic Interstitial Nephritis). In either case as
the tubules are also involved, it is also called Tubulo-Interstitial Disease.
Acute interstitial nephritis are
almost always cuased by an abnormal action of the immune system. It is very similar
to an allergic reaction - except that it is limited almost exclusively to the kidney. The
causes that trigger such immune reaction are many. Most of them are
understandably medications: Some of those medications are:
Arthritis Medications
Pain Medications
Antibiotics
Chronic interstitial nephritis
are usually due to one or a combination of the following:
1. Toxicity of various toxins and chemicals (medications) in high concentrations
accumulating in the tubules and interstitium. Some of those
medications are
as listed above, under acute interstitial nephritis.
When such nephritis is due to 'Pain-Medications' it is called Analgesic
Nephropathy
When such nephritis is
due to Non-Steroidal-Anti-Inflammatory Drugs (NSAID) like
Motrin, Advil, Naprosyn, Alieve etc., then it
is called NSAID-Nephropathy
2. Lack of adequate oxygen supply to the interstitial tissues and tubules - usually due to
blood vessel abnormalities unable to deliver the oxygen carrying blood.
3. Chronic low grade abnormal reaction of the immune system
SYMPTOMS OF ACUTE AND CHRONIC INTERSTITIAL
NEPHRITIS:
1. Symptoms of acute interstitial nephritis are as listed
under acute renal
failure and nephritis
2. Symptoms of chronic interstitial nephritis are insidious and are listed under
chronic renal
failure.
TREATMENT OF ACUTE AND CHRONIC INTERSTITIAL NEPHRITIS:
1. Remove / treat the cause
2. Measures listed under the treatment of acute renal failure
3. At times, immuno-suppression with steroids in acute variety
4. If the chronic renal failure is established, then measures as listed under Chronic
Renal Failure
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