Fire in the kidneys

Proven content

You need to take care of your kidneys, because their diseases can have serious consequences. However, we can not always quickly find out that something is happening to them. This is the case with inflammation.

The kidneys are the most important part of the urinary system, a fine filter in the body that we couldn’t live without. It enables the removal of harmful substances and metabolic products, drugs or the excess of certain micronutrients, e.g. sodium. The kidneys filter approx. 180 liters of fluid every day, and the final product of this process is approx. 1,5 liters of urine. Every day, urine is removed through the urinary tract – renal pelvis, ureters, bladder and urethra.

The tasks of the kidneys, in addition to filtering, include regulation of water and electrolyte balance and maintaining a constant volume and composition of body fluids. Each disruption of their work causes serious malfunctions in the functioning of the whole organism. This is what happens with inflammation of the kidneys. They are afflicted by both men and women of different ages, e.g. primary glomerulonitis occurs in young people (more often in boys), and secondary in different age populations. Infections occur at any age; bacterial infections more often affect young women during sexual activity and elderly women. It is assumed that about 4 million Poles suffer from chronic kidney disease.

(Read more about birth defects of the urinary system! – editorial note)

Acute glomerulonephritis. Onset: upper respiratory tract infection

Acute glomerulonephritis is an immune-mediated disease where the glomerular capillaries are damaged. It generally begins with an acute upper respiratory tract infection (often streptococcal). Already during the fever, transient hematuria (invisible to the naked eye, diagnosed only on the basis of microscopic examination) occurs. After 8-12 days (the so-called latency period) there is a feeling of general discomfort, dull pains in the lumbar region, sometimes nausea, vomiting, headaches. This is accompanied by swelling (especially under the eyes), arterial hypertension, and sometimes tachycardia. Daily urine output decreases; it is in the color of the meat washes. In the urine there are changes characteristic of damage to the renal glomeruli – rolls composed of red blood cells. In more severe cases, there is a risk of damage to the heart muscle or the development of uremia.

Inflammatory changes in the capillaries reduce blood supply to the kidneys and reduce glomerular filtration. On the other hand, the permeability to proteins and other components that is excessively present in the urine, which is detrimental to health, increases.

You should see a doctor in the event of malaise, weakness, swelling, decreased urine output, changes in its appearance. Acute glomerulonephritis can be detected by urine tests and blood counts.

Doctors advise patients to rest completely. The diet should be easy to digest, low in sodium, and you should limit the amount of fluids you drink. In case of high arterial hypertension, antihypertensive (pressure-lowering) drugs are used, in case of circulatory failure – cardiac drugs. Antibiotics are given to fight the streptococcal infection. The disease can be completely cured, but in some patients glomerulonephritis may become chronic.

Chronic glomerulonephritis

Few symptoms, long mileage

Chronic glomerulonephritis can last for years, with periods of exacerbation and remission. It has an immunological background, similar to the acute form. Patients may first complain of headaches, apathy, and aching pains in the lumbar region. Doctors call this disease oligosymptomatic. The first symptoms are proteinuria, hematuria, rolleruria of varying and variable intensity (recognized in urine laboratory tests). Sometimes nephrotic syndrome and arterial hypertension appear early. When most of the renal parenchyma is destroyed, uremia develops.

An alarm signal prompting a visit to a doctor should be symptoms such as weakness, headaches, visual impairment, edema, hypertension, and foaming of urine.

The aim of treatment is to reduce proteinuria and preserve kidney function so that it does not fail. Therapy depends on the form of glomerulonephritis, which we can only recognize from a kidney biopsy. It is necessary when the daily proteinuria exceeds 0,5 g. Here, agents suppressing the activity of the immune system are used in order to suppress the immune-inflammatory reaction in the kidneys. The most common are hormones of the adrenal cortex and immunosuppressants. Unfortunately, such therapy is not always effective, and drugs also have their side effects, but in the absence of absolute contraindications and the presence of high proteinuria, treatment should be initiated.

Chronic forms of glomerulonephritis can lead to uremia. Worse prognosis are cases with arterial hypertension, large proteinuria, and rapid increase in plasma creatinine concentration. They lead to end-stage renal failure, which requires renal replacement therapy in the form of dialysis or transplantation.

Can chronic glomerulonephritis be prevented? So far, it is impossible, because medicine does not have data on its causes.

Pyelonephritis

Bacterial attack

It is bacteria such as coliform, faecal streptococcus or golden staph is caused by pyelonephritis (inflammation of the renal pelvis). They attack the kidney tissue and the renal pelvis. It is worth emphasizing that infections generally also affect the remaining parts of the kidneys, not only the pelvis.

Bacteria enter the kidneys through the “ascending” route from the urinary tract, most often due to an untreated cystitis. That is why it is so important – as part of prophylaxis – to carefully treat all bladder inflammations. Less frequently, bacteria reach the bloodstream or lymphatic route – from another inflammatory focus, e.g. from the tonsils. The infection is favored by urine stagnation in the pelvis, ureters or bladder (urolithiasis, prostatic enlargement in older men). Pregnant women are also often affected by such situations.

Chills, a high fever, a feeling of dull pressure in the lumbar region are typical symptoms of this disease. When it is an “ascending” infection, they are also accompanied by bladder complaints – pain when urinating, frequent urge to bladder, blood in the urine. In the urine, large amounts of bacteria and leukocytes (a typical symptom of acute inflammation) are detected during the examination. In case of fever and / or pain in the lumbar region or dysuria (urgency, burning sensation when urinating, frequent painful urination in small amounts), it is essential to see a doctor.

Until the fever subsides, the sick must lie down. In more severe, complicated cases, a hospital stay may even be necessary. It is essential to take antibiotics. After recovery, follow-up examinations (urinalysis and culture) are recommended to check that the urine is free of bacteria and that the acute stage has not become chronic. A kidney ultrasound should always be performed to check for an obstruction in outflow of urine.

Note – untreated chronic multiform inflammation can lead to complete destruction of the kidney parenchyma! If only one kidney is sick, the other one takes over. Otherwise, dialysis is essential in the end stage of the disease.

Acute interstitial non-bacterial nephritis

It accompanies other diseases

Acute interstitial non-bacterial nephritis is a rare form of nephritis. It occurs in the course of infectious diseases (e.g. typhoid fever, scarlet fever, sepsis) or under the influence of drug allergy. There are pathological changes in the kidney tissue. Severe swelling of the kidneys leads to water retention in the body.

The onset of the disease in cases caused by hypersensitivity to the drug is rapid – fever, skin lesions, acute renal failure. If inflammation accompanies another disease, dull pains appear in the renal area. In more severe cases, oliguria (oliguria), anuria (anuria), edema and uremia can occur.

The most important thing here is to combat the underlying disease. In cases caused by hypersensitivity to drugs, they are discontinued and steroids are recommended, while in anuria, treatment such as in acute renal failure (conservative or dialysis) is used.

Text: Anna Romaszkan

Consultation: prof. dr hab. med. Magdalena Durlik, head of the Clinic of Transplantation Medicine and Nephrology, Institute of Transplantology, Medical University of Warsaw

Source: Let’s live longer

Read more about urinary tract defects in children!