Glomerulonephritis

Glomerulonephritis

1. Definition
   Glomerulonephritis is a group of kidney disorders in which the glomeruli – the tiny filtering units of the kidney – become inflamed, leading to impaired filtration of blood.

2. Causes / Etiology

• Post‑infectious (e.g., after streptococcal throat infection)
• Autoimmune diseases such as systemic lupus erythematosus
• Vasculitic disorders (e.g., Wegener’s granulomatosis)
• Certain drugs (e.g., penicillamine, gold salts) and toxins
• IgA deposition after mucosal infections (IgA nephropathy)

3. Types or Classification
   Acute glomerulonephritis – sudden onset of inflammation, often following an infection.
   Chronic glomerulonephritis – long‑standing inflammation causing gradual loss of renal function.
   Membranous glomerulonephritis – thickened glomerular basement membrane with subepithelial immune deposits.
   IgA nephropathy (Berger’s disease) – dominant IgA deposits in the mesangium, usually after respiratory infections.
   Rapidly progressive (crescentic) glomerulonephritis – rapid decline in kidney function with crescent formation on biopsy.
   Minimal change disease – almost normal light microscopy; massive protein loss (nephrotic syndrome).

4. Pathology (stepwise)
   Step 1 → Immune complexes or antibodies bind to glomerular capillary walls (or direct toxic injury).
   Step 2 → Complement activation and recruitment of inflammatory cells (neutrophils, macrophages).
   Step 3 → Release of enzymes and cytokines → damage to endothelial cells and basement membrane.
   Step 4 → Increased permeability of the filtration barrier → hematuria and proteinuria.
   Step 5 → Reduction in glomerular filtration rate (GFR) → rise in serum creatinine and possible edema.

5. Clinical Features
   General – swelling of feet and face (edema), high blood pressure, dark coloured urine (hematuria), frothy urine (proteinuria), reduced urine output.
   Specific –
    Nephritic picture: cola‑colored urine, mild to moderate proteinuria, hypertension, periorbital edema.
    Nephrotic picture: massive proteinuria (>3 g/day), hypo‑albuminemia, generalized edema, hyperlipidaemia, fatty casts in urine.

6. Complications
   Acute – acute kidney injury, pulmonary edema due to fluid overload, electrolyte disturbances (hyperkalaemia, metabolic acidosis).
   Chronic – progression to chronic kidney disease, eventual end‑stage renal disease requiring dialysis or transplantation, secondary hypertension, cardiovascular disease.

7. Diagnosis / Investigations
   Routine –
    Urinalysis: red blood cell casts, protein, haematuria.
    Blood: serum creatinine, urea, electrolytes, complement levels (C3, C4).
    Blood pressure measurement.
   Special –
    Renal ultrasound: size, cortical thickness, rule out obstruction.
    Renal biopsy: gold standard to identify type (immune deposits, crescents, basement membrane changes).
    Serology: anti‑DNA antibodies (lupus), ANCA (vasculitis), ASO titre (post‑streptococcal).

8. Management
   General – control of blood pressure (target <130/80 mm Hg) using ACE inhibitors or ARBs, restrict salt intake, use loop diuretics for edema, monitor fluid balance.
   Modern – immunosuppressive therapy according to type: corticosteroids, cyclophosphamide, mycophenolate mofetil, rituximab for refractory cases; plasmapheresis in rapidly progressive disease.
   Dietary advice – low‑sodium diet (≤2 g salt/day), moderate protein (0.8 g/kg/day) to reduce nitrogen load, adequate calories, limit fluids if oliguric, avoid high‑potassium foods if hyperkalaemia present.

9. Homeopathic Therapeutics (key remedies)

Apis mellifica

• Swelling of kidneys with feeling of fullness.
• Urine scanty, dark and painful.
• Burning sensation relieved by cold applications.
• Good for edema with oliguria.
• Helpful when there is a history of insect bite or sting.
• Improves renal inflammation with fever.

Cantharis

• Severe burning pain in the urinary tract, especially during micturition.
• Hematuria with a “coca‑cola” coloured urine.
• Urine passes in drops with great effort.
• Useful when there is a history of urinary infection.
• Relieves intense thirst and dryness of mouth.
• Good for patients who are irritable and restless.

Lycopodium clavatum

• Swelling of abdomen and kidneys with a feeling of heaviness.
• Tendency to develop ascites and pleural effusion.
• Worse on the left side, better after warm drinks.
• Appetite poor for heavy foods, craving for sweets.
• Useful in chronic kidney disease with low‑grade fever.
• Improves digestion and liver‑kidney coordination.

Natrum muriaticum

• Edema with a tendency to retain fluids in the lower limbs.
• Urine is scanty, dark, with a salty taste.
• Patient often emotionally sensitive, prefers solitude.
• Good for chronic glomerulonephritis with intermittent haematuria.
• Works well when there is a history of grief or suppressed emotions.
• Helps to restore normal electrolyte balance.

Terebinthina (Cicuta virosa)

• Sharp, cutting pain in the flank with haematuria.
• Urine passes with great difficulty, often with clots.
• Patient feels cold, shivers, and has a desire for warm drinks.
• Useful in rapidly progressive glomerulonephritis with crescents.
• Improves renal circulation and reduces protein loss.
• Beneficial when there is a history of exposure to toxic substances.