Glomerulonephritis: How to Diagnose and Prevent It at Various Levels

Glomerulonephritis is an inflammation of the glomeruli in the kidney. The glomeruli is constellation of small blood vessels in the kidney that act as a filter to remove excess fluid, electrolytes and nitrogenous wastes from the blood into the urine.

It is divided into:

Acute Glomerulonephritis- The symptoms develop suddenly.

Chronic Glomerulonephritis- The symptoms develop gradually.

In glomerulonephritis, the glomeruli lose their filtering capacity thus blood proteins and red cells are excreted in the urine in various quantities depending on the severity of the glomerular damage.

DIAGNOSIS OF GLOMERULONEPHRITIS
Accurate diagnosis is essential in the successful treatment of glomerulonephritis.

Diagnosis is highly dependent on the clarity of symptoms, examination and investigation findings.

SYMPTOMS
· Passage of coca-colored urine due to the presence of red blood cells in the urine. This is called haematuria.

· Passage of foamy urine due to excess amount of proteins in the urine. This is called proteinuria.

· Presence of peri-orbital and ankle swelling.

EXAMINATION FINDINGS
· Peri-orbital and pedal edema.

· Elevated blood pressure.

INVESTIGATIONS
· Urinalysis-This reveals diagnostic findings such as red blood cells, casts, white blood cells and proteins in the urine.

· Blood test- Blood level of electrolytes, urea and creatinine. This is mainly done to assess the extent of kidney damage.

· Radiological imaging tests-This is done usually when the blood tests suggest some level of kidney damage. E.g Renal scan or abdominal CT scan is done.

· Kidney biopsy- This entails using a clinical procedure to extract some pieces of kidney tissues for microscopic examination. This is the only test that confirms glomerulonephritis.

TREATMENT
This is based on the following principles:

· Treat underlying health conditions quickly.

· Use of corticosteroids to reduce the degree of inflammation and immunological responses.

· Dialysis- This is used for individuals with acute kidney injury or kidney failure.

· Anti-hypertensives such as ACEI, ARBs- This is used to control hypertension in some selected individuals.

PREVENTION STRATEGIES
There are 3 levels of prevention namely: primary, secondary and tertiary.

PRIMARY PREVENTION
The aim of this is to prevent the onset of glomerulonephritis.

It entails the following

· Throat swab should be done for suspected bacteria cause of sore throat. If streptococcus is suspected, oral penicillin should be commenced as soon as possible.

· Prompt treatment of individuals with bacteria endocarditis.

SECONDARY PREVENTION
This involves early diagnosis and prompt treatment of glomerulonephritis.

It specifically entails the following:

· Routine urinalysis to be done periodically for individuals at risk of streptococci infections and for individuals greater than 40 years.

· Periodic monitoring of blood urea and creatinine levels should be done for individuals with compromised kidney function.

TERTIARY PREVENTION
This involves activities and interventions put in place for individuals with glomerulonephritis from developing complications such as kidney failure and to reduce the disease progression.

· Optimal control of co-morbidities like hypertension and diabetes mellitus.

· Reduce intake of high protein diet.

· Restrict salt intake.

· Cessation of smoking.

· Regular clinic follow up by a Nephrologist.

Finally, glomerulonephritis is a very lethal kidney disease of which the onset and progression can be prevented if an individual adheres to the activities in the various levels of prevention highlighted above.