Acute Glomerulonephritis

Glomerulonephritis is a medical condition where the glomeruli in the kidneys become inflamed. The glomeruli are involved in the removal of uremic waste. Acute Glomerulonephritis occurs when the inflammation is sudden and severe. Children in the age group 2 - 12 years are more likely to suffer Acute Glomerulonephritis. This disease can also affect those suffering from diabetes, hepatitis or lupus. Typically Acute glomerulonephritis follows a streptococcal infection, such as strep throat, tonsillitis or scarlet fever. Viral infections such as HIV or hepatitis B or hepatitis C can bring on an attack of acute glomerulonephritis.

Symptoms of glomerulonephritis include fatigue, nausea and loss of appetite. There might be flu-like symptoms including fever. Joint pains and blood in the sputum are also noticed in patients suffering from glomerulonephritis. Shortness of breath and high blood pressure may be experienced. There might be blood and protein in the urine. Often Chronic glomerulonephritis is not manifested in any symptoms and is discovered only with a physical examination. Complications such as high blood pressure and kidney failure can occur if it is left untreated.

Mild cases of glomerulonephritis are not treated unless the symptoms become severe. CT scan allows the doctor to visualize the kidneys. Urine is checked for increased levels of protein. Blood tests reveal any streptococcal antibodies or low blood count. A biopsy is often done to determine the cause for Glomerulonephritis.

Treatment for acute glomerulonephritis involves improving the functioning of the kidneys and reducing the damage to the glomeruli. A diet with reduced intake of sodium, protein and fluids is recommended. The patient suffering from acute glomerulonephritis is advised bed rest to facilitate better blood flow to the kidneys. Antibiotics are often prescribed to treat residual infection. Diuretics aid in better output of urine. In cases of renal failure, temporary dialysis or kidney transplant are considered.

ANA blood test

Antinuclear antibodies (ANA) refer to the unusual antibodies that are detectable in the blood. ANA are gamma-globulins type of antibodies that are found in patients with certain autoimmune diseases. ANA are directed against certain components found in the nucleus of a cell in the body. These antibodies have the capacity of binding certain structures within the nucleus of the cells. The ANA test was first designed by Dr.George Friou in 1957. The laboratory blood test exposes the antibodies in the serum of the blood to cells. It is then determined whether or not antibodies are present that react to various parts of the nucleus of cells. Hence the term 'anti-nuclear' antibody is used.

Fluorescence techniques are adopted to detect the ANA antibodies in the cells. Thus ANA testing is sometimes referred to as fluorescent antinuclear antibody test (FANA). Nowadays, a method to detect antinuclear antibodies called enzyme linked immunosorbent assay (ELISA) is replacing the previous method of immunofluorescent assay technique. The ELISA method is less likely to produce false positive ANA result than the previous method.

Patterns also give doctors a clue as to the type of illness to look for while evaluating a patient. For instance, the disease Scleroderma shows in nucleolar pattern. If a person does not have any autoimmune disease, it is defined in speckled pattern. An ANA blood test is used in patients who might be suffering from Sjogren's syndrome, rheumatoid arthritis, polymyositis, scleroderma, Hashimoto's thyroiditis, juvenile diabetes mellitus, Addison's disease, vitiligo, pernicious anemia, glomerulonephritis and pulmonary fibrosis. ANA can also be found in patients with conditions that are not considered autoimmune diseases such as chronic infections and cancer.

The result of the ANA test is expressed in titers. A titer of 1 to 80 (1:80) means that antibodies could be last detected when 1 part of the blood sample was diluted by 80 parts of another liquid. Usually this other liquid is a diluted salt solution. A larger second number indicates that the antibodies are present in greater concentration. Therefore a titer of 1 to 320 indicated higher concentration of antibodies in the blood than a titer of 1 to 80. The normal values of ANA blood test is : Titer below 1: 20 or 1:40 depending on the test method used.

Positive ANA test result is suggestive of autoimmune disease. It can also mean that the patient has drug induced lupus. Some drugs and infections can also induce false positive ANA test results. Steroids can cause a false-negative result. Medications, especially antibiotics such as isoniazid, penicillin, and tetracycline, birth control pills, lithium and some diuretics such as chlorthalidone can interfere with the test and affect the accuracy of the ANA test result.

Uremia

Uremia is regarded as the end stage of Kidney Failure. Uremia is also called the 'second cancer'. Uremia is related to the second point filtering blood. The kidney is impaired and does not filter the waste products that result from the body's metabolism. When this function fails, the waste products and blood urea nitrogen accumulate in the bloodstream. This build-up is Azotaemia. Mild levels of azotaemia may not show symptoms. But continued kidney failure to filter the waste result in symptoms and this condition is called uremia.

Uremic patients show varied signs and symptoms collectively called as uremic syndrome.

Gastrointestinal tract: Loss of appetite, discomfort in the abdomen, nausea, vomiting, diarrhea, severe dehydration, oral ulcer, Glossitis (inflammation of the tongue) and urine taste in breath.

Nerves related: Headache, dizziness, lethargy, drowsiness, weakness, fatigue. In advanced stage symptoms such as irritability, muscle trembling, seizures and convulsions may be experienced.

Cardiovascular system: Hypertension and arrhythmia and in the advanced stage heart failure can happen.

Blood forming or hematopoietic system: Serious anemia and in the advanced stage bleeding can happen.

Respiratory system: Shortness of breath, difficulty breathing, chronic cough, respiratory disorders such as pleural effusion (fluid accumulation in the lungs), pneumonia, uremic bronchitis, pleurisy.

To decide on the course of treatment the cause of Uremia is of great significance. As Uremia can be life-threatening, quick and proper treatment may reverse the illness condition. The chief cause is of course, kidney failure or damage to kidneys.

Diseases that affect kidney function:

• Bright disease - Glomerulonephritis
  
  
• Chronic hypertension
  
  
• Diabetes mellitus
  
  
• Kidney diseases (Kidney failure, Kidney anomalies)
  
  
• Bladder cancer
  

Body conditions:

• Urinary stones that block flow of urine
  
  
• Enlarged prostate glands (in males)
  
  
• Injury to kidney
  
  
• Renal artery occlusion or embolism
  
  
• Cardio vascular problems (excessive bleeding, congestive heart failure)
  
  
• Gastro-metabolic disorder (diarrhea, vomiting, severe dehydration)
  
  
• Burns
  
  
• Lupus
  

How is Uremia diagnosed?

Most renal disease including Uremia do not cause symptoms in the early stages. Uremia is likely to be noticed incidentally from blood or urine tests done for other health issues. Urinalysis is done to detect protein and blood in urine. Blood clotting test, kidney biopsy and stool culture to ascertain presence of a certain type of E.coli bacteria or other bacteria.

• A normal hemoglobin level is below 80g/L. In persons with symptoms of Uremia, the level may decline to 40-60g/L. Also, the platelets or leukocyte levels may be high.
  
  
• In persons with symptoms of Uremia, BUN increases from its normal value of less than 20 mg/dL to approximately 80-100.
  
  
• A 24-hour urine sample for creatinine clearance is taken. If the test result shows below the normal of less than 1.0 mg/dL to approximately 10, there is a high possibility of renal failure.
  
  
• Estimated Glomerular Filtration Rate or eGFR is a measure that filtering and waste removal function of the kidneys. eGFR falls to less than 10-15 ml/1.73 m2.
  
  
• Calcium, phosphate, parathyroid hormone, albumin, potassium and Bicarbone- abnormalities prevalent in these are also observed as part of blood tests.

How is Uremia treated?

If the diagnosis is confirmed, the patient would be hospitalized for observation and treatment. The cause determines the treatment.

• Patients with diarrhea require intravenous fluids or re hydration and rebalancing of electrolytes like sodium and potassium which is lost with diarrhea. This is the immediate supportive care.
  
  
• Severely anemic patients are given blood transfusion when the hemoglobin falls below 6 or 7 gdL.
  
  
• Plasma exchange or plasmapherisis is usually for adults patients who are likely to have an abnormal chemical in the plasma stimulating abnormal clot formation. To rectify and balance, the plasma is removed and replaced with donor plasma.
  
  
• is done to filter the waste out of the blood while the kidneys recover.
  
  
• Kidney transplant is another choice.
  
  
• Eculizumab (Soliris) is an intravenous infusion approved by the FDA for the treatment of pediatric and adult patients with atypical hemolytic uremic syndrome (aHUS). Atypical Hemolytic-uremic syndrome is a syndrome characterized by three major problem areas, progressive renal failure, problems associated with red blood cell and platelet counts and problems that occur in the vascular system.