Inflammatory Diseases of the Kidneys

Nephritic Syndrome

This is often caused by infection from streptococcal bacteria, but may be caused by viruses or other types of infections. Nephritic Syndrome may be acute or chronic. The latter may go undetected for years, but is associated with a high blood pressure.

Nephritic syndrome is characterized by:

• reduction in kidney function
  • oedema (or swelling),
  • a reduced volume of urine (oliguria)
  • hypertension caused by salt and water retention
  • blood in the urine (haematuria)
  • protein in the urine (proteinuria)
  • uraemia

Treatment / Management

There is no specific treatment for Nephritic Syndrome. It depends on the cause and clinical features.

Nephrotic Syndrome

This is a collection of symptoms and signs. The most common cause (about 50%) is glomerulonephritis, but it can also be caused by diabetes mellitus, viral diseases, malignant disease, multiple myeloma, amyloid disease, systemic lupus erythematosis, and some drugs (penicillamine and gold, which are used to treat Rheumatoid Arthritis).

Due to a large amount of protein being excreted in the urine, there is a low serum protein, usually associated with a high cholesterol, swelling (oedema) around the eyes, periphery of the limbs and abdomen, the urine may be frothy because of protein content, and may contain fat. The affected person is also more susceptible to clots (thrombotic disease). It can occur at any age.

Treatment / Management

Management is bed rest, restriction of dietary salt and diuretic therapy.

Chronic Kidney Disease (Most common)

There are people who are at increased risk of developing chronic kidney disease and these are the following:

• Those with a family history of kidney disease
• Those with diabetes
• Those with high blood pressure

Chronic kidney disease is classified in 5 stages, of increasing severity, using the value of glomerular filtration rate (GFR), which involves blood and urine collection estimated using a formula, which takes into account the creatinine serum value, age, race and gender.

Normal range of GFR is 80 – 120 ml/ minute.

It ranges from:

• Stage 1 – Normal GFR in which the GFR is around normal (greater than 90 ml per minute), but there is other evidence of chronic kidney disease.
• Stage 2 is mild impairment – GFR is 60-89 ml/ min with other evidence of chronic kidney disease.
• Stage 3 is moderate impairment
  • GFR is 30-59ml/min
  • (3A GFR=45-49 ml/min)
  • (3B GFR=30-44 ml/min)
• Stage 4 is severe impairment - GFR is 15-29 ml/min
• Stage 5 is established renal failure where GFR less than 15 ml/min

(This is also known as end-stage renal failure and at this stage patients need dialysis or kidney transplant to survive)

Amended April 2008