Glomerulonephritis: Symptoms, Diagnosis, and Kidney Biopsy Insights

What is glomerulonephritis?

Hello Dr.
Hong: My mother has recently experienced swelling in her legs and foamy urine.
She mentioned that she had previously experienced lower limb edema and foamy urine, but the swelling subsided after a while, and she didn't pay much attention to it.
The attending physician indicated that these are symptoms of kidney disease.
Blood and urine tests were conducted, an ultrasound was performed, and a 24-hour urine collection was done.
Her kidney function is within the normal range; however, the doctors have told my mother that it could be glomerulonephritis and that further kidney biopsy is needed.
Is that true? Could you please explain what glomerulonephritis is and how a kidney biopsy can help? Thank you.

Ding, 20~29 year old female. Ask Date: 2006/02/15

Dr. Hong Yaomin reply Rare Disease

The primary function of the human kidneys is to facilitate excretion.
Each kidney is composed of approximately two million nephrons, which can be simply categorized into the glomerulus, renal tubules, and interstitium.
The glomerulus acts like a filter, responsible for filtering substances from the blood.
Normally, the glomerulus allows only small molecules in plasma, such as glucose, electrolytes, and water, to pass through, while larger molecules like proteins do not.
Therefore, the amount of protein in urine formed by healthy kidneys is very low, typically not exceeding 0.15 grams per day.
However, when the glomeruli become inflamed, urine may contain a significant amount of protein, and sometimes red blood cells from the bloodstream may also be filtered into the urine.
If chronic glomerulonephritis is left untreated, inflammation can lead to fibrosis, commonly referred to as "scarring," resulting in a gradual loss of function.
At this stage, the glomerular filtration rate decreases, and blood biochemical tests will show elevated levels of urea nitrogen and creatinine.
Once all the glomeruli in the kidneys undergo chronic fibrosis and lose their function, the kidneys will gradually shrink and progress to uremia.
So, how is glomerulonephritis detected? Early glomerulonephritis may present with proteinuria and/or hematuria.
In fact, glomerulonephritis is a general term that can be classified into various types based on pathological findings under a light microscope.
A kidney biopsy (also known as renal biopsy) is necessary for detailed examination under a microscope to differentiate between these types.
After renal pathological examination, not only can the specific type of glomerulonephritis be identified, but the extent of acute inflammation or fibrosis in the glomeruli can also be assessed, which aids in evaluating the prognosis of the disease and the effectiveness of immunosuppressive therapy.
Collecting a 24-hour urine sample can help calculate the total protein excretion.
Typically, if the 24-hour urine protein exceeds 2 grams, or if the patient has hypertension or abnormal serum creatinine levels, a nephrologist may recommend a kidney biopsy to clarify the underlying cause.

Kaohsiung Veterans General Hospital, Department of Nephrology, Dr.
Hong Yao-Min.

Reply Date: 2006/02/15

More Info

Glomerulonephritis is a term that encompasses a variety of kidney disorders characterized by inflammation of the glomeruli, which are the tiny filtering units within the kidneys. This condition can lead to significant health issues, including proteinuria (excess protein in the urine), hematuria (blood in the urine), and edema (swelling), particularly in the legs and feet, as you've observed in your mother.

Symptoms of Glomerulonephritis
The symptoms of glomerulonephritis can vary widely depending on the underlying cause and severity of the condition. Common symptoms include:
1. Edema: Swelling in the legs, ankles, or around the eyes due to fluid retention.

2. Foamy Urine: This is often a sign of proteinuria, where excess protein in the urine creates a frothy appearance.

3. Blood in Urine: This can appear as pink, red, or cola-colored urine, indicating the presence of red blood cells.

4. High Blood Pressure: Kidney inflammation can lead to increased blood pressure.

5. Fatigue: General tiredness or weakness due to the body’s inability to filter waste effectively.

Diagnosis of Glomerulonephritis
Diagnosing glomerulonephritis typically involves a combination of clinical evaluation and laboratory tests:
1. Urinalysis: This test checks for the presence of blood, protein, and other substances in the urine.

2. Blood Tests: These assess kidney function by measuring levels of creatinine and urea in the blood.

3. Imaging Studies: Ultrasound may be used to visualize the kidneys and check for structural abnormalities.

4. 24-Hour Urine Collection: This helps quantify proteinuria, which is crucial for diagnosis.

Given that your mother has experienced symptoms like edema and foamy urine, and her doctor suspects glomerulonephritis, further investigation is warranted.

Kidney Biopsy
A kidney biopsy is a critical diagnostic tool in the evaluation of glomerulonephritis. This procedure involves taking a small sample of kidney tissue, which is then examined under a microscope. Here’s how a kidney biopsy can help:
1. Identifying the Type of Glomerulonephritis: There are various forms of glomerulonephritis, such as minimal change disease, focal segmental glomerulosclerosis, and membranous nephropathy. Each type has different implications for treatment and prognosis.

2. Assessing Severity: The biopsy can reveal the extent of inflammation and damage to the glomeruli, which helps in determining the severity of the disease.

3. Guiding Treatment: Understanding the specific type of glomerulonephritis can guide treatment decisions, including whether to use immunosuppressive medications or other therapies.

Importance of Early Diagnosis and Treatment
Early diagnosis and appropriate treatment of glomerulonephritis are crucial to prevent progression to chronic kidney disease or kidney failure. If left untreated, chronic inflammation can lead to scarring of the kidney tissue, ultimately resulting in a decline in kidney function.

Conclusion
In summary, your mother's symptoms of edema and foamy urine are indeed concerning and warrant further investigation for glomerulonephritis. A kidney biopsy is a valuable tool that can provide essential information about the type and severity of the condition, which is critical for determining the best course of treatment. It is important to follow your healthcare provider's recommendations and ensure that your mother receives the necessary evaluations and interventions to manage her kidney health effectively.

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