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What to know about the Nephritis-2020

What to know about the nephritis?


It is a diseased condition of kidneys where it involves different areas of kidney structure. Before starting with the definition of nephritis let have a look at the basic functional parts of our excretory organ.

Anatomy of kidney


  Human kidneys serve to convert more than 1700 L of blood per day into about 1 L of highly concentrated urine.

They excrete waste products of metabolism, precisely regulates the body’s concentration of water, salt, calcium, phosphorus, anions, cations and maintains the appropriate acid balance of plasma.

They also act as an endocrine organ, secreting hormones such as erythropoietin, rennin, prostaglandins and regulate vitamin D metabolism.

The kidneys are divided into 4 basic morphological components: glomeruli, tubules, interstitium, and blood vessels.

The blood is brought into a kidney via large lumen renal artery. This artery divides further into smaller and smaller branches.

The thin arterioles reach the glomeruli with the oxygenated blood full with waste products generated in the process of metabolism by the liver.

The glomeruli have a sieve-like structure with pores that have certain dimensions to not let proteins, RBC and other major components to even pass through.

  Further, the tubules have a function to maximally recover water and essential salts from the filtrate. This happens via counter current mechanism (the blood and filtrate move in opposite directions with a permeable membrane to exchange the minerals and water in alternate steps).

In the case of nephritis, the tubules and the interstitium are in an inflammatory state. With a compromise in function of kidneys, waste products will get accumulated in the body and thus lead to other systemic problems.


NEPHRITIS can be split into “NEPHR” + “ITIS”. “ITIS” means inflammation.
NEPHRITIS is a condition in the functional unit of the kidney, the nephron, become inflamed.

There are many types of nephritis occur with a range of causes. Some develop nephritis quickly in a short time while others enter the chronic state without much notice by the patient, so they require treatment in a different way.

Types of Nephritis

Acute glomerulonephritis-

The disease is seen in acute streptococcal infection, hepatitis, and HIV. It may also develop in cases of lupus or other chronic conditions as an acute case.

The damage caused is by immune complexes. The WBC particularly leucocytes occur as exudates in the urine.

 In a streptococcal infection, the immune complex containing streptococcal antigens and antibodies get deposited at the membrane of glomeruli.

Alport nephritis-

It is a congenital condition where the mutations lead to defective collagen synthesis. The defect lies in the assembly of type 4 collagen, which is crucial for the function of glomeruli, the lens of the eye and the cochlea of the ear. Seen more common in men.

Signs



  • Appear at 5 – 20 yr of age
  •  Microscopic hematuria
  •  Proteinuria
  •  Eye lens dislocation
  •  Cornea changes


Chronic glomerulonephritis-

The end-stage glomerular disease may be a progression of earlier kidney disease. There are no specific signs of the disease. It may show as loss of appetite, anaemia, vomiting or weakness.

It is usually discovered as proteinuria, hematuria on examination by a doctor.

IgA Nephropathy (Berger Disease)-

The disease is basically the presence of IgA deposits in the nephron. IgA is the main immunoglobulin formed by the mucosal secretions to prevent the entry of organisms into the body at the level of the mucosa.

The defect is believed to be hereditary or acquired where the abnormal IgA results in an autoimmune response. The body generates other antibodies against it, thus complexes are formed which get deposited in glomeruli.


The problem goes unnoticed if one does not get to doctor for a checkup, even knowing of certain issues faced by him/her.

Even the doctor may miss if the patient is already suffering from hypertension, proteinuria, etc.

Lupus nephritis-

Now in cases, the kidneys are involved-


  • Foamy urine- due to high protein content may be one of the cause 
  • High blood pressure Lupus erythematosus is an autoimmune disease involving multiple organs, with abundant antinuclear antibodies, leading to injury caused by the deposition of the antibodies. Antibodies to Double-stranded DNA and so-called smith antigen are diagnostic of SLE. 


Tissue injury by SLE is by mechanisms-


  1. Type 3 hypersensitivity
  2. Autoantibodies for red cells, white cells, and platelets opsonize these cells and promote phagocytizes and lyses.
  3. Antiphospholipid antibody syndrome- a person may develop arterial and venous thrombosis.
  4. Neuron complications of SLE have been attributed to antibodies that react with neurons or receptors for neurotransmitters and cross the blood-brain barrier.

Symptoms


The patient is a young woman with-

  • Butterfly rash over the face
  • Fever
  • Pain
  • Pleuritic chest pain
  • Photosensitivity
  • Pedal edema- swelling of legs, ankles, and feet. To check the edema of ankles and feet, press the ankle on the inner side for 30 sec and release. If there is a small pit formed at for site for a prolonged time then it is a danger sign for kidney functioning.




Lupus has various remission episodes of attack even after all the symptoms get subdued.
So ideally, one should consult doctor time with regular check-ups.                                       

Causes-

Various causes may be there in damage caused to the kidneys. The defects also seem to run in families of affected and in cases, the cause may not be even clear.

Hepatitis B, hepatitis c, HIV and other like septic shock are known to cause damage.

In other cases, people these days are much dependent on medications. Drugs like aspirin, acetaminophen, and naproxen have shown to be a damaging factor for kidneys over time.

Antibiotics particularly aminoglycosides are nephrotoxic, ototoxic (damaging effect to inner ear components), others are antifungal like amphotericin B, cisplatin (used in cancer chemotherapy) cause extensive damage in a short time.

Risk factors-

These are the factors for which the patients are prone to develop a kidney disease


  • High blood pressure
  • Diabetes- leads to damage as the sugars are passed into the urine. Later on the pores widen and allow even the proteins (albumin, immunoglobulin) to pass through urine.
  • Obesity
  • Heart disease
  • Age more than 60 yrs
  • Congenital systemic disorders

When to visit a doctor


In cases of change in urine color to pink or brown, caused due to blood in the urine. Otherwise, any symptoms list up are major changes to confirm your visit to the doctor.

Early diagnosis and treatment are important, as the remaining functions of kidneys are possible to be preserved.

Diagnosis-


In cases of nephritis, the doctor may send your blood sample reports for investigation of raised blood urea, raised creatinine, low protein levels (in severe cases like pedal edema).

The urine is sent for examination to check the extent of protein excreted in urine, sugars, nitrogen wastes and others like pus cells.

In times when the doctor is able to figure out the situation, he/she may ask for a biopsy report of kidneys to check structural changes in kidneys.

Treatment-


Usually, acute nephritis resolves on itself with maintenance care in hospitals.
It requires medication to remove excess fluids and dangerous proteins.

Chronic nephritis requires diuretics( also called water pills) to remove excess fluids for long intervals. Regular check-up is required to maintain blood pressure, which has a damaging effect on kidneys. Diuretics with BP medication work best in such cases.

In cases of autoimmune diseases, various immunosuppressants are used to suppress the attack on kidneys.

When the patient is out of danger from the acute kidney problem. The doctor usually suggests consulting a dietician. This will help in improvement in a diet plan of person and hence improves electrolyte balance for kidneys.

Prevention


Even though it is not possible to always escape of nephritis but by adopting certain habits will definitely result in lower episodes of nephritis-

Maintain a healthy weight –Having a good BMI with an active lifestyle will certainly have positive effects like efficient excretion of nitrogen wastes, less build-up of wastes over long periods.

Quit smoking- smoking has its ill effects on health as it damages the epithelial lining of vessels, other vast undefined bad changes.

Keeping blood pressure, blood sugar in the normal range.
Exercise regularly
Quit refined foods-
           normal table salt contains a high amount of sodium chloride. This is a refined salt obtained after extracting all other minerals in processing.

It is better to use rock salt, Himalayan salt, desert salt instead of regular salt. Other refined things are white sugar, all-purpose flour, refined oils, all other products that undergo high processing mechanisms.

Instead of above we can use whole wheat flour, cold-pressed oils, brown sugar,    and other green veggies as our daily diet.

Outlook-




Although kidney problems like nephritis may not be curable the damage can be prevented by early intervention by a doctor.

In cases where the patient doesn’t go for doctor investigation, he/she may land into irreversible kidney failure. Such patients have to regularly undergo dialysis until their rest of life.

Another option may be to get a kidney transplant, which itself is not an easy way of treatment.

It is better to follow doctors advice.


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