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Glomerulonephritis (Kidney Disease) in the Elderly

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Glomerulonephritis (GN) is a medical condition due to inflammatory changes in the glomeruli, the bed of tiny blood vessels that starts the filtering process in the kidney. It can be sudden onset (acute) or chronic (gradually developing). Depending on the the cause, glomerulonephritis can be primary in that it occurs on its own or secondary when it is due to some other disease. It can lead to renal failure where there is a complete shutdown of kidney function. It is an important type of kidney disease in seniors because it can arise with long standing diabetes mellitus and hypertension, two common chronic ailments in the senior years.

Symptoms of Glomerulonephritis

Commonly occurring symptoms of glomerulonephritis, irrespective of the cause includes :

  • Cola colored, rust or brownish colored urine due to blood.
  • Frothy (foamy) urine due to excretion of excess amount of proteins.
  • Generalized body swelling due to water retention.

Other associated symptoms depending upon the cause of glomerulonephritis includes :

  • Fever.
  • Diarrhea.
  • Painless nose bleeding.
  • Pain in the abdomen.
  • Bloody vomiting.
  • Large volume urine production.
  • Breathlessness with cough.
  • Body ache (malaise).
  • Weakness, lethargy and paleness due to anemia occurring in chronic renal failure.

Glomerulonephritis can cause damage to the filtering tubules of the kidney thereby compromising its normal activities. As a result there is accumulation of toxic waste products in the body which lead to further damage to the kidney as well as other organs.

These complications of glomerulonephritis includes :

  • Acute renal failure: sudden shutdown of kidney function.
  • Chronic renal failure: slow deterioration of kidney function.
  • Raised blood pressure (hypertension or worsening of existing hypertension).

Causes of Glomerulonephritis

There are number causes that can lead to glomerulonephritis, although sometimes the exact cause cannot be identified. Some causes are more likely to be seen in younger adults and children, while other cause are more frequently encountered in the elderly. It is, however, important to consider all possible causes.

Infections

  • Post-streptococcal glomerulonephritis is usually seen in children. Antibodies produced due to infection with Streptococci (skin bacteria or sore throat bacteria) may induce inflammatory changes in kidney. The heart valves are also commonly affected where it is referred to as rheumatic heart disease.
  • Bacterial endocarditis where there is an infection of the inner lining of the heart commonly affecting the heart valves as well.
  • Viral infections with certain virus (like HIV, hepatitis B and C) may lead to the development of glonerulonephritis.

Immunity

In immune-related causes of glomerulonephritis, the immune system attacks different tissues throughout the body and may also target the glomeruli of the kidneys. These diseases include :

  • Goodpasture’s syndrome
  • Systemic lupus erythematosus (SLE)
  • IgA nephropathy
  • Vasculitis – polyarteritis and Wegener’s granulomatosis.

Injury

The glomeruli may become damaged due to injury that is neither related to an infection or immune factors. These are common causes of glomerulonephritis in the elderly. The two most likely causes includes :

  • High blood pressure (hypertension).
  • Long standing diabetes.

People who are at a greater risk of glomeruli damage, apart from infectious and immune causes, includes those with :

  • Amyloidosis
  • Frequent intake of NSAIDs.
  • Cancer.
  • Hydrocarbon solvent exposure.

Treatment of Glomerulonephritis

Treatment depends upon the cause, severity or nature of glomerulonephritis. Acute cases may require more aggressive treatment but can even resolve spontaneously in some cases without any need for treatment. Chronic glomerulonephritis needs ongoing treatment. Apart from treating the kidney dysfunction, the treatment should also be directed at the underlying cause which can then ease glomerulonephritis or at least prevent it from progressing rapidly. Treatment may include :

  • Antihypertensive drugs for hypertension.
  • Antibiotics for bacterial infections.
  • Corticosteroids and immunosuppresants for immune related causes.

Kidney failure is usually managed with dialysis and kidney transplantation.


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