Each kidney contains about 1-3 million nephrons and they are the functional unit of the kidney.Each nephron contains a structure called the glomerulus through which the bloodvessels pass and the waste products of the body get purified.

Glomerulonephritis is the term used to describe a group of diseases that damage the part of the kidney that filters blood. When the kidney is damaged, it cannot get rid of wastes and extra fluid in the body. If the illness continues, the kidneys may stop working completely.

                                                 

Glomerular diseases damage the glomeruli, letting protein and sometimes red blood cells leak into the urine. Sometimes a glomerular disease also interferes with the clearance of waste products by the kidney, so they begin to build up in the blood. Furthermore, loss of blood proteins like albumin in the urine can result in a fall in their level in the bloodstream. In normal blood, albumin acts like a sponge, drawing extra fluid from the body into the bloodstream, where it remains until the kidneys remove it. But when albumin leaks into the urine, the blood loses its capacity to absorb extra fluid from the body. Fluid can accumulate outside the circulatory system in the face, hands, feet, or ankles and cause swelling.

Acute:The acute form develops suddenly. You may get it after an infection in your throat or on your skin. Sometimes, you may get well on your own.Other times, your kidneys may stop working unless effective treatment is started quickly. 
The early signs of the acute disease are: 

· proteinuria: large amounts of protein in the urine
· hematuria: blood in the urine
· reduced glomerular filtration rate: inefficient filtering of wastes from the blood
· hypoproteinemia: low blood protein
· edema: swelling in parts of the body

One or more of these symptoms can be the first sign of kidney disease. But how would you know, for example, whether you have proteinuria? Before seeing a doctor, you may not. But some of these symptoms have signs, or visible manifestations

Signs and symptoms of kidney failure include:

• lack of appetite
• nausea and vomiting
• fatigue
• difficulty sleeping
• dry and itchy skin
• muscle cramps, especially at night.

Broadly we can divide the causes as follows:

A. Autoimmunity: When the body's immune system functions properly, it creates protein-like substances called antibodies and immunoglobulins to protect the body against invading organisms. In an autoimmune disease, the immune system creates autoantibodies, which are antibodies or immunoglobulins that attack the body itself. Autoimmune diseases may be systemic and affect many parts of the body, or they may affect only specific organs or regions. 
B. Heredity: Sometimes this disease runs in families –
This kind often shows up in young men who may also have hearing loss and vision loss.
C. Infective : Glomerular disease sometimes develops rapidly after an infection in other parts of the body. Acute post-streptococcal glomerulonephritis (PSGN),HIV etc. 
D. Sclerotic diseases: This means scarring of the glomeruli by various sysytemic and local causes. Example : Diabetes, Lupus disease etc.
E. Idiopathic – Cause of the disease is unknown. 

How is a diagnosis of glomerulonephritis made?

The first clues are your signs and symptoms. Finding protein and blood cells in your urine is another sign. Blood tests will help the doctor tell what type of illness you have and how much it has damaged your kidneys.

Sometimes, your doctor will need to do a kidney biopsy by taking a tiny piece of your kidney with a special needle. This will help the doctor plan the best treatment for you.

How can glomerulonephritis be prevented?

 Good hygiene, "safe sex" and avoiding IV drugs are helpful in preventing infections that could lead to this illness.

If you have the chronic type, it is very important to control your blood pressure since this may slow down kidney damage. Your doctor may tell you to eat less protein. A dietitian who is trained to work with kidney patients (a renal dietitian) can be very helpful in planning your diet.

    Acute Form :

   It may go away by itself. Sometimes you may need medication or even temporary treatment with an artificial kidney machine to remove extra fluid and control high blood pressure and kidney failure. Antibiotics are not used for acute glomerulonephritis, but they are important in treating other forms of disease related to infection. If your illness is getting worse rapidly, you may be put on high doses of medicines that affect your immune system. Sometimes, your doctor may order plasmapheresis, a special blood filtering process to remove harmful proteins from your blood.

  Chronic Form:

There is no specific treatment for the chronic form of the illness. Your doctor may tell you to:

• eat less protein, salt and potassium
• control your blood pressure
• take diuretics
• take calcium supplements.

What are its complications?

·         Acute nephritic syndrome

·         Chronic renal failure

·         End-stage renal disease

·         Hypertension

·         Malignant hypertension

·         Fluid overload -- congestive heart failure, pulmonary edema

·         Chronic or recurrent urinary tract infection

·         Increased susceptibility to other infections

A special diet can help to control the buildup of waste products and fluid in your blood and to decrease the workload of your kidneys. This diet may also help to slow down the loss of kidney function. The main goal of the diet is to keep you healthy. Your doctor may recommend a special diet, depending on the stage of your disease. If and when this diet is ordered for you, your doctor may want you to see a renal dietitian, who has special training in diet for kidney disease.

What if I am diabetic?

In some cases, you may need to make only a few changes in your diabetic diet to fit your needs as a kidney patient. If your doctor suggests that you eat less protein, you must be sure to get enough calories from other sources. 

What is the diet like?

In general, the diet used for the early stages of kidney disease controls the amount of protein and phosphorus you eat. Usually, sodium is also controlled. Getting enough calories to maintain a healthy weight is very important at this time. 

Protein:

Your body needs protein every day for growth, building muscles and repairing tissue. After your body uses the protein in the foods you eat, a waste product called urea is made. If you have lost kidney function, your kidneys may not be able to get rid of this urea normally. You may need to reduce the amount of protein you eat to avoid buildup of urea in your body. Protein is found in two types of foods: 

in large amounts in foods from animal sources such as poultry, meat, seafood, eggs, milk, cheese and other dairy products. 
in smaller amounts in foods from plant sources such as breads, cereals, other starches and grains, and vegetables and fruits. 
While you may need to limit the amount of protein you eat, it is important that you eat the right amount of protein. This helps to keep your body healthy. 

Calories:
Calories give you energy. Because you are getting fewer calories from protein, you will need to get more calories from other foods. Your dietitian may recommend that you get these extra calories from sugar and vegetable fats to help you get the right amount of calories. 

Avoid losing too much weight because it can cause malnutrition and lead to illness. 

Some ways to increase calories are as follows: 

Increase unsaturated fats such as vegetable oils (made with corn, cottonseed, safflower, soybean or sunflower oils), olive oil and mayonnaise type salad dressings. 
Use sugar or sweets such as hard candy, gum drops, jelly beans, marshmallows, honey, jam and jelly. 
Use canned or frozen fruits in heavy syrup. 
If you are diabetic or overweight, talk with your renal dietitian about the best way for you to get the right amount of calories for your needs. 

What will happen if I don't follow this diet?

Your special diet may help to slow the loss of kidney function and to protect you from malnutrition. In later stages of kidney disease, the diet may also help you control the amount of waste products in your blood. If these waste products build up to very high levels, they may cause nausea, vomiting, hiccups, tiredness, weakness, sleepiness and other disorders. 

Will my diet change over time?

Your diet may change as your kidney function changes. In the early stages of your kidney disease, your diet may be reduced in protein. If dialysis or a kidney transplant is needed, your diet will change based on the treatment option you choose. 

Will I have to take vitamins and minerals?

Vitamins and minerals come from a variety of foods you eat each day. If your diet is limited, you may need to take special vitamins or minerals. Take only the vitamins and minerals your doctor orders for you. Certain vitamins may be harmful to people with kidney disease. 

What if I am diabetic?

In some cases, you may need to make only a few changes in your diabetic diet to fit your needs as a kidney patient. If your doctor suggests that you eat less protein, you must be sure to get enough calories from other sources. 

What if I am a vegetarian?

Vegetarian diets by nature are high in potassium and phosphorus because of all the vegetables, whole grains and fruits that make up the diet. A vegetarian diet that includes eggs and milk is easier to work into the renal diet. The goal is to eat the right combinations of plant proteins while keeping potassium and phosphorus under control. 

Can diet help prevent the bone disease seen in many kidney patients?

Yes. Calcium and phosphorus are two minerals important for healthy bones. Diseased kidneys are unable to remove phosphorus from the blood as well as they should. Too much phosphorus in your blood may lead to loss of calcium from your bones. This may cause your bones to become weak and to break easily. 

As mentioned earlier, phosphorus comes from many foods in your diet. By eating fewer high phosphorus foods, you reduce the amount of phosphorus in your blood, which reduces calcium loss from your bones. Your doctor may order a medicine called a phosphorus binder to keep your body from absorbing phosphorus from foods. This medicine should be taken with your meals and snacks as your doctor orders.