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Nephritis

Nephritis is a condition, characterized by inflammation of the kidneys, which is majorly caused by infections, autoimmune diseases or exposure to toxins. The kidneys constitute of the glomerulus, interstitial tissue and tubules.


Presentation

Some of the common symptoms of nephritis include the following [6]:

  • Feeling of pain and burning sensation during urination
  • Presence of blood and pus in the urine
  • Fever accompanied by vomiting 
  • High blood pressure in individuals who have developed glomerulonephritis
  • Pain in the pelvic region, kidneys and or abdomen
  • Development of edema in the face, legs and hands due to accumulation of fluid
  • Frequency in urge to urinate
  • Urine is cloudy in appearance 
Anosmia
  • Male patient, 72 years-old, was admitted on hospital service with clinical complaint of asthenia, loss of strength, emaciation, and anosmia. Previous history included type 2 diabetes mellitus.[ncbi.nlm.nih.gov]
Recurrent Abdominal Pain
  • The frequencies of persistent purpura (31 vs. 10%, p   0.0001), recurrent abdominal pain (16 vs. 7%, p   0.011), gastrointestinal bleeding (25 vs. 10%, p   0.0001), and corticosteroid use (54 vs. 41%, p   0.023) were significantly higher in the former[ncbi.nlm.nih.gov]
Regurgitation
  • One patient received aortic valve replacement therapy for aortic regurgitation with vegetation, and the other underwent tricuspid valve replacement therapy and closure of a ventricular septic defect to treat tricuspid regurgitation with vegetation.[ncbi.nlm.nih.gov]
Epigastric Pain
  • A 42-year-old Chinese man presented with repeated epigastric pain, sausage-shaped pancreas observed morphologically in computed tomography, effectiveness of prednisone therapy and was diagnosed with autoimmune pancreatitis.[ncbi.nlm.nih.gov]
Periodontitis
  • This is the first published case to show NAPlr positivity in the glomeruli after systemic infection with the periodontal bacteria, Aggregatibacter actinomycetemcomitans.[ncbi.nlm.nih.gov]
Purpura
  • The objective of this study was to evaluate prevalence, initial risk factors, and outcomes in Henoch-Schönlein purpura nephritis (HSPN) patients in Latin America.[ncbi.nlm.nih.gov]
  • Henoch-Schönlein purpura nephritis (HSPN) involves the renal impairment of Henoch-Schönlein purpura and can easily relapse into life-threatening late nephropathy in severe cases.[ncbi.nlm.nih.gov]
  • Henoch-Schonlein purpura (HSP), HSPN and a healthy control group.[ncbi.nlm.nih.gov]
  • Henoch-Schonlein purpura, also called IgA-vasculitis, is a systemic small vessels vasculitis with immunoglobulin A1-dominant immune deposits. The optimal treatment remains controversial.[ncbi.nlm.nih.gov]
  • Henoch-Schönlein purpura is a systemic vasculitis characterized by IgA deposits, which target the skin, joints, and kidneys, among other organs. In children, prognosis is often good but little is known about biomarkers of pediatric nephritis.[ncbi.nlm.nih.gov]
Bone Pain
  • We report a 39-year-old male who presented with polydipsia, polyuria, and multiple bone pain.[ncbi.nlm.nih.gov]
Hand Deformity
  • Manifestation Prevalence, % Systemic: Fatigue, malaise, fever, anorexia, weight loss 95 Musculoskeletal 95 Arthralgias/myalgias 95 Nonerosive polyarthritis 60 Hand deformities 10 Myopathy/myositis 25/5 Ischemic necrosis of bone 15 7.[slideshare.net]
Periorbital Edema
  • Her physical examination revealed that she had bilateral pitting leg edema and periorbital edema. She was not pale or icteric. She had evidence of mild synovitis of the small joints of the hand bilaterally with no deformities.[ncbi.nlm.nih.gov]
  • edema Coagulopathy Physical findings Focal and diffuse lupus nephritis – Generalized active SLE with the presence of a rash, oral or nasal ulcers, synovitis, or serositis; signs of active nephritis Active lupus nephritis – Hypertension, peripheral edema[emedicine.medscape.com]
Dry Eyes
  • She had a long history of dry eyes for which she had been using artificial tears. pSS serology was positive and she underwent renal biopsy which demonstrated TIN. Subsequent urinary acidification testing demonstrated dRTA.[bmcmusculoskeletdisord.biomedcentral.com]
Encephalopathy
  • The first case was a 3-year-old girl who had neurological symptoms, including unconsciousness and seizures, with AFBN associated with acute reversible encephalopathy.[ncbi.nlm.nih.gov]
  • Complications Primary complications associated with hypertension include: Seizure Encephalopathy Stroke End-organ damage Posterior reversible encephalopathy syndrome [4, 5 ] Primary complications associated with kidney failure include: Fluid overload[emedicine.medscape.com]
  • Children with severe lead poisoning can present with encephalopathy and acute renal failure with Fanconi syndrome.[emedicine.medscape.com]
Meningism
  • A small number of reported cases are accompanied by neurological symptoms, including meningeal irritation, unconsciousness, and seizures. We experienced 2 rare cases of AFBN associated with central nervous system lesions.[ncbi.nlm.nih.gov]
  • Manifestation Prevalence, % Neurologic 60 Cognitive disorder 50 Mood disorder 40 Headache 25 Seizures 20 Mono-, polyneuropathy 15 Stroke, TIA 10 Acute confusional state or movement disorder 2–5 Aseptic meningitis, myelopathy 9.[slideshare.net]

Workup

Various tests would be required for diagnosing the condition of nephritis. These would include the following [7]:

  • Laboratory studies: Several laboratory investigations would be required such as blood urea nitrogen levels, urine culture along with urinalysis and complete blood count. Blood tests to analyze levels of electrolyte and creatinine would be done. In addition to these, other laboratory studies include lupus serologies, antiDNAase B, serum IgA measurement, measurement of components C3 and C4, antistreptolysin and cellular antineutrophil cytoplasmic antibody. These tests would help detect infection in general and also give insights about presence of a bacterial infection [8] [9].
  • Biopsy: Biopsy of the kidney would be required when the patient shows signs of edema, proteinuria, hypertension and hematuria.
  • Imaging: Imaging studies such as CT scan of the abdomen and pelvic region is indicated to check for signs of infection. In addition to this, renal ultrasonography is done to rule out other conditions of tumor, kidney stones, renal artery stenosis and hematuria.
Hyponatremia
  • Low to normal BP Polyuria 2nd to NDI Typically seen with chronic K depletion ( 3.0 mEq/L) Minimal proteinuria Majority have reduced eGFR and azotemia Severity of renal impairment correlated with duration and degree of potassium depletion Associated: hyponatremia[renalandurologynews.com]
Human Parvovirus B19
  • We conclude that human parvovirus B19 infection should be considered as a cause of lupus-like symptomatology and acute glomerulonephritis.[ncbi.nlm.nih.gov]
  • The deposition of human parvovirus B19 Ag – anti-human parvovirus B19 Ab complexes in the glomerulus is thought to be responsible for human parvovirus B19-associated nephritis .[omicsonline.org]
Streptococcus Bovis
  • Each had bacteremia, due to Enterococcus faecium in one and Streptococcus bovis in the other.[ncbi.nlm.nih.gov]

Treatment

The primary goal of treatment would be to correct the underlying disease condition that is causing nephritis. For this, medications and certain home care measurement would be required to treat the condition. Medications such as antibiotics are required if bacterial infections are the source of the problem. If autoimmune reactions are the cause, then various immunosupressants would be administered.

Individuals with nephritis should give special considerations to their diet and their activity profile. Sodium and fluid restriction would be required if the patient is suffering from hypertension as the underlying condition. Along with this, a high carbohydrate diet would also be recommended for a short period in order to prevent breakdown of body protein. Calcium supplementation would also be indicated to maintain the normal serum calcium levels [10]. Individuals are also advised against carrying out strenuous activity; however, they are permitted to undertake daily light activities.

Prognosis

Prognosis of the condition is favorable with prompt initiation of treatment. However, failure to do so can cause damage to the organs, causing kidney failure. In such cases, individuals may require dialysis for filtering off the wastes from the body. Mortality due to nephritis in children is found to be higher in cases when there is development of complications. The several complications involved with kidney failure include uremia, anemia, overload of fluids, electrolyte imbalance, anorexia, sexual dysfunction and poor growth [5].

Etiology

Autoimmune diseases are the major cause of nephritis. Following this, the condition can also occur due to infections and exposure to toxins. Individuals suffering from systemic lupus erythematosus are at an increased risk of developing nephritis. There have been instances, where nephritis can also be caused by heredity. However, such cases are rare and nephritis is majorly caused either by infections or autoimmune diseases. A kind of nephritis, known as athletic nephritis occurs as a result of excessive strenuous exercises. Such a type of condition gives rise to cylindruria, proteinuria and hematuria [2].

Epidemiology

The exact incidence of nephritis across the globe is unknown. Based on the statistics given by Center for Disease Control and Prevention, it was reported that approximately 39,480 people die due to nephritis in US each year. In addition, kidney disease was ranked 9th as the leading cause of mortality amongst the US population [3].

Sex distribution
Age distribution

Pathophysiology

Kidneys form an important organ of the body, responsible for maintain water and electrolyte balance, regulate acid-base concentration, and filtering off metabolic wastes. These bean-shaped organs process about 200 quarts of blood everyday and remove excess water and waste products from the body. Conditions interfering with the normal functioning of the kidneys are infections and underlying disease conditions.

These factors promote development of inflammation of the organ which can further lead to kidney damage. In addition to infection and disease conditions, individuals can also develop nephritis if they have undergone surgical procedures of the kidneys or are allergic to certain medications [4].

Prevention

Certain practices can help prevent the onset of infections which would in a way avoid the onset of nephritis. Healthy living and appropriate water consumption can help keep the bladder clean and also avoid infections. Alcohol consumption and smoking are known to cause damage to the kidney and should therefore be avoided. Certain fruits and vegetables act as natural diuretics and should be made a part of daily diet. These consist of grapes and coconut water.

Summary

There are three types of nephritis, interstitial nephritis, glomerulonephritis and pyelonephritis. In interstitial nephritis, the area between the renal tubules undergoes inflammation. In the condition of glomerulonephritis, the filtering units of the kidneys, the glomeruli, get inflamed. Pyelonephritis occurs as a result of infection of the bladder, favoring development of inflammation of the kidneys. Nephritis, if not treated on time can turn severe, leading to development of several complications such as kidney damage [1].

Patient Information

  • Definition: Nephritis is a condition, wherein the kidneys undergo inflammation usually either due to infections or autoimmune diseases. Such a type of condition should be promptly treated in order to avoid development of kidney damage.
  • Cause: The various causative factors for nephritis include bacterial infections, autoimmune diseases, and allergic reactions to antibiotics and or surgical procedures of the kidney. All these factors can trigger an inflammatory response, giving rise to nephritis.
  • Symptoms: Individuals with nephritis suffer from pain during urination, frequency in urge to urinate, pain in the abdomen and pelvic region, fever as well as vomiting. Affected individuals also experienced swelling in the arms and legs due to accumulation of fluids and also pass out blood in urine.
  • Diagnosis: The various diagnostic procedures employed include blood tests, blood culture, urinalysis, urine culture, complete blood count and serology tests. In addition, kidney biopsy would be required in individuals who suffer from hematuria, edema, proteinuria and hypertension.
  • Treatment: Antibiotic medications form the basis of treatment regime. Dietary restrictions along with fluid control would also be done in order to correct the condition of nephritis.

References

Article

  1. Michel DM, Kelly CJ. Acute interstitial nephritis. J Am Soc Nephrol 1998; 9:506.
  2. Cornell LD. IgG4-related kidney disease. Curr Opin Nephrol Hypertens 2012; 21:279.
  3. Buysen JG, Houthoff HJ, Krediet RT, Arisz L. Acute interstitial nephritis: a clinical and morphological study in 27 patients. Nephrol Dial Transplant 1990; 5:94.
  4. Rossert J. Drug-induced acute interstitial nephritis. Kidney Int 2001; 60:804.
  5. Paueksakon P, Revelo M, Lee SM, et al. Acute renal failure in a 64-year-old white man.Am J Kidney Dis 2000; 36:669.
  6. Goda C, Kotake S, Ichiishi A, et al. Clinical features in tubulointerstitial nephritis and uveitis (TINU) syndrome. Am J Ophthalmol. 2005;140(4):637-41.
  7. Wen YK, Chen ML. IgA-Dominant Postinfectious Glomerulonephritis: Not Peculiar to Staphylococcal Infection and Diabetic Patients. Ren Fail. 2011;33(5):480-5.
  8. Lins RL, Verpooten GA, De Clerck DS, De Broe ME. Urinary indices in acute interstitial nephritis. Clin Nephrol 1986; 26:131.
  9. Cornell LD. IgG4-related kidney disease. Curr Opin Nephrol Hypertens 2012; 21:279.
  10. Flanc RS, Roberts MA, Strippoli GF, et al. Treatment of diffuse proliferative lupus nephritis: a meta-analysis of randomized controlled trials. Am J Kidney Dis. Feb 2004;43(2):197-208.

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Last updated: 2017-08-09 17:57