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nephritis

  nephritis

     inflammation of the kidney; a focal or diffuse proliferative or destructive disease that may involve the glomerulus, tubule, orinterstitial renal tissue. Called also Bright's disease. The most usual form is glomerulonephritis, that is, inflammation of theglomeruli, which are clusters of renal capillaries. Damage to the membranes of the glomeruli results in impairment of thefiltering process, so that blood and proteins such as albumin pass out into the urine. Depending on the symptoms itproduces, nephritis is classified as acute nephritis, chronic nephritis, or nephrosis (called also the nephrotic syndrome).

  Acute Nephritis. This occurs most frequently in children and young people and seems to strike those who have recentlysuffered from sore throat, scarlet fever, and other infections caused by streptococci; it is believed to originate as animmune response on the part of the kidney. An attack may produce no symptoms, but more often there are headaches, arundown feeling, back pain, and perhaps slight fever. The urine may look smoky, bloody, or wine-colored. Analysis of theurine shows the presence of erythrocytes, albumin, and casts. Another symptom is edema of the face or ankles, morecommon in the morning than in the evening. The blood pressure usually rises during acute nephritis, and in severe caseshypertension may be accompanied by convulsions.

  Treatment consists chiefly of bed rest and a carefully controlled diet. Penicillin is often used if an earlier streptococcalinfection is still lingering. Recovery is usually complete. In a small percentage of cases, however, acute nephritis resistscomplete cure. It may subside for a time and then become active again, or it may develop into chronic nephritis. Dialysismay be indicated in patients with fluid overload that is refractory to diuretics, or who become clinically uremic.

  Chronic Nephritis. Chronic nephritis may follow a case of acute nephritis immediately or it may develop after a longinterval during which no symptoms have been present. Many cases of chronic nephritis occur in people who have neverhad the acute form of the disease. Symptoms are often unpredictable and variable from case to case, but there is almostalways steady, progressive, permanent damage to the kidneys.

  Chronic nephritis generally moves through three stages. In the first stage, the latent stage, there are few outwardsymptoms. There may be slight malaise, but often the only indication of the disease is the presence of albumin andother abnormal substances in the urine. If a blood count is made during this stage, anemia may be found. There is nospecial treatment during the latent stage of chronic nephritis. The patient can live a normal life but should avoid extremesof fatigue and exposure and should eat a well balanced diet.

  The first stage may be followed by a second stage, in which edema occurs in the face, legs, or arms. The maintreatment in this stage consists of a low-protein, low-sodium diet and diuretics. Steroid hormones may be helpful.

  At the final stage of chronic nephritis is end-stage renal disease. Treatments are kidney transplant and dialysis. At anystage of chronic nephritis it is particularly important to avoid other infections, which will aggravate the condition.

  There is no known cure for chronic nephritis, although the progress of the disease can be delayed, so that the patientcan live an almost normal life for years. Many patients are being helped by repeated purification of their uremic blood byhemodialysis or peritoneal dialysis, or by transplantation.

  glomerular nephritis glomerulonephritis.

  interstitial nephritis nephritis with increase of interstitial tissue and thickening of vessel walls and malpighiancorpuscles; it may be due to overuse of analgesics, mercury poisoning, gout, or any of various other conditions.

  lupus nephritis glomerulonephritis associated with systemic lupus erythematosus.

  potassium-losing nephritis see under nephropathy.

  radiation nephritis kidney damage caused by ionizing radiation; symptoms include glomerular and tubular damage,hypertension, and proteinuria, sometimes leading to renal failure. It may be acute or chronic, and some varieties do notmanifest until years after the radiation exposure.

  salt-losing nephritis salt-losing nephropathy.

  transfusion nephritis nephropathy following transfusion from an incompatible donor as a result of the hemoglobin of thehemolyzed red blood cells being deposited in the renal tubules.

  tubulointerstitial nephritis nephritis of the renal tubules and interstitial tissues, usually seen secondary to a drugsensitization, systemic infection, graft rejection, or autoimmune disease. Characteristics include lymphocytes in interstitialinfiltrate and within tubules, mild hematuria, and pyuria. Acute tubulointerstitial nephritis is usually seen as acomplication of infection or allergy. Chronic tubulointerstitial nephritis is when the condition has progressed to interstitialfibrosis with shrunken kidneys, a lowered glomerular filtration rate, and danger of renal failure.

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