Pharmacotherapy/Treatment Of Glomerulonephritis

Glomerulonephritis is the inflammation of the tiny blood vessels in the kidney. These tiny blood vessels are called glomeruli. There are millions of them. They filter urine removing protein and other useful substances and allowing waste to go out of the body.

When the glomeruli is damaged as in glomerulonephritis, it can no longer remove waste and excess fluid from the body efficiently. Also, it allows important substances such as blood and protein to be excreted from the body.

Types Of Glomerulonephritis

There are two types of glomerulonephritis. Some books put it at three. They are acute, subacute and chronic glomerulonephritis.

Acute glomerulonephritis is also called primary glomerulonephritis. It occurs suddenly. It can lead to chronic glomerulonephritis. The most common cause is infection.

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Chronic glomerulonephritis is also called secondary glomerulonephritis. It is gradual and occurs over a long period of time. It can be due to an acute episode of glomerulonephritis. The most common cause is diabetes, drugs, etc.

Symptoms Of Acute Glomerulonephritis

1. Brown or bloody urine

2. Decrease urination

3. Fluid in lungs leading to coughing and shortness of breath

4. High blood pressure

5. Puffiness of the face on waking up.

Symptoms Of Chronic Glomerulonephritis

Symptoms of chronic glomerulonephritis develop over time without obvious symptoms. Symptoms might include;

1. Blood or protein in urine

2. High blood pressure due to retention of salt

3. Swollen ankle or face because of fluid retention

4. Frequent urination at night

5. Bubbles or foam in urine cause by excess protein

General Symptoms

1. Poor appetite

2. Tired and weak (muscle cramp)

3. Nausea and vomiting

4. Kidney pain

5. No urination for 2-3 days

Cause

Poststreptococcal glomerulonephritis is caused by bacterial endocarditis, immune disease like lupus, goodpasture syndrome, IgA nephropathy which results from deposit of immunoglobulin A in the glomeruli. Others are polyarteritis, granulomatosis with polyangiitis.

Risk Factor

1. Streptococcal infection of the throat

2. Impetigo

3. Tuberculosis

4. Syphilis

5. Human immunodeficiency virus

6. Hepatitis B and C

7. Non steroidal antiinflammatory drugs e.g ibuprofen or aspirin

8. Hodgkin disease

9. Sickle cell

10. Systemic disease like diabetes nephropathy and high blood pressure

Glomerulonephritis management

Diagnosis

1. Test to detect waste e.g nitrogen, urea, creatine in blood and protein or blood in urine.

2. Testing for antigens and antibodies in the blood

3. Kidney function tests involve examining blood and urine samples that shows the level of certain substances released by the kidney such as sodium, potassium and urea as well as if the person is producing less urine than usual.

4. Kidney biopsy involves using small needles to take a sample of kidney tissue.

5. X-ray, ultrasound and CT scan are other means of diagnosis.

Pathophysiology Of Glomerulonephritis

Glomerulonephritis is as a result of formation of immune complexes. The kidney may be enlarged up to 50 percent. The glomerular tufts swells with infiltration with polymorphonucleocytes. Immunofluorescence reveals deposition of immunoglobulin and complement.

In poststreptococcal glomerulonephritis (PSGN), derivatives of streptococcal proteins have been reported. A streptococcal neuraminidase may alter host immunoglobulin G (IgG). IgG combines with host antibodies IgG/anti-IgG immune complexes are formed and then collect in the glomeruli. In addition, elevation of antibody titers to other antigens such as antistreptolysin o and anti hyaluronidase, DNAse-B and streptokinase provide evidence of a result streptococcal infection.

Prevention

Control of hypertension and diabetes goes a long way in reducing inflammation of the glomeruli. Also, treatment of streptococcal infections and impetigo is advisable. Lifestyle that exposes one to these infections must be avoided. They include safe sex, smoking cessation, weight reduction and avoid sharing of sharp objects. Others are a quality exercise schedule, quality sleep and an adequate diet. Avoid drinks containing alcohol and foods high in protein, salt and potassium.

Complications

1. Heart failure

2. Hypertension

3. Pulmonary oedema

4. Damage to other organs when waste products build-up and kidney function drops to less than 10 percent of its normal capacity

Pharmacotherapy/Treatment Of Glomerulonephritis

Treatment depends on the cause and the extent of damage to the glomeruli. Presence of antibodies for streptococcal infections will require the use of antibiotics. The most used antibiotic for streptococcal infections is the penicillin such as amoxicillin. Amoxicillin 500mg is taken every 8 hours for seven days. Better option is amoxicillin/clavulanic acid taken 12 hours interval for 7 days or every 8 hours for 5 days.

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Glomerulonephritis caused by high blood pressure is managed with diuretics such as hydrochlorothiazide taken one tablet a day. Hydrochlorothiazide is best taken in the morning due to its diuretic effect. Other implicated disease must be adequately treated.

The control of inflammation is best achieved with corticosteroids such as prednisolone taken 5mg daily or as prescribed. Immunosuppressant such as cyclophosphamide also helps in the control of inflammation by stoping the body's own immune response.

Dialysis is the last stage of treatment in which waste is removed from the body with the help of a machine. Plasmapheresis is used to remove plasma with antibodies from the body and replace it with other fluids and donated plasma. Last option is kidney transplant.