Chronic Conditions

Nephritis/Nephrosis


Nephritis/Nephrosis refers to a large group of kidney conditions, comprising chronic glomerulonephritis and chronic kidney disease.

a) Glomerulonephritis 


Glomerulonephritis is a disease that causes very tiny blood vessels in the kidneys to be inflamed and damaged. This disorder can be inherited or can be due to other underlying conditions such as autoimmune diseases (e.g. Systemic Lupus Erythematosus). This affects the function of the kidney and reduces its ability to filter waste products and fluids from the blood. Glomerulonephritis may be acute (develops suddenly) or chronic.

Symptoms of chronic glomerulonephritis include:

   • Small amount of blood in urine (may not be visible to the naked eye)
   • Foamy urine (due to proteins in urine)
   • Frequent urination at night
   • Swelling, most commonly in the ankles or face (due to fluid build-up)
   • High blood pressure


Diagnosis

The condition is usually discovered when patients complain of symptoms of glomerulonephritis or from routine urine tests during health screenings. Once glomerulonephritis is suspected, your doctor may perform these tests to confirm the diagnosis and ascertain the type of glomerulonephritis prior to starting treatment:

   • Urine test. A urinalysis may find red blood cells, white blood cells and proteins which may indicate kidney inflammation and damage.
   • Blood tests. These can provide information about the degree of kidney damage by measuring the level of waste products in the blood.
   • Imaging tests. Imaging tests (e.g. ultrasound) may also be recommended to visualise the kidneys.
   • Kidney biopsy. A definitive diagnosis of glomerulonephritis often involves inserting a needle to remove a small sample of kidney tissue for microscopic examination.


b)
Chronic Kidney Disease

Chronic kidney disease is the slow progressive loss of kidney function over time, which may ultimately lead to permanent kidney failure. The most common cause of chronic kidney disease in Singapore is diabetes. Other less common causes may include glomerulonephritis.

Symptoms of chronic kidney disease vary, but they may include:

   • Appetite loss/ Nausea/ vomiting
   • Generalised body pains and aches
   • Fatigue and weakness
   • Persistent itching

Diagnosis

Blood tests can be used to determine the amount of waste products in the blood and this can be used to estimate the degree of damage done to the kidneys. Other tests may include urine tests and imaging tests (e.g. ultrasound).


a) Glomerulonephritis

Aside from treating the underlying specific causes, your doctor may also advise you to:
   • Eat less protein, salt and potassium
   • Control your blood pressure
   • Take diuretics (water pills) to treat puffiness and swelling

In general, the goal of treatment is to protect your kidneys from further damage.


b) Chronic kidney disease

Depending on the underlying cause, some types of chronic kidney failure can be treated. Often, though, chronic kidney failure has no cure. Treatment consists of measures to help control signs and symptoms of chronic kidney failure, reduce complications, and slow the progress of the disease:

   • High blood pressure medications. Control of blood pressure is important to preserve kidney function and protect it from further deterioration.
   • Medications to lower cholesterol levels. Your doctor may recommend medications to lower your blood cholesterol level. People with chronic kidney failure often experience high levels of bad cholesterol, which can increase the risk of heart disease.
   • A lower protein diet to minimize waste products in the blood. As the body processes protein from foods, it creates waste products that the kidneys must filter from the blood. To reduce the amount of work your kidneys must do, your doctor may recommend eating less protein. Your doctor may also ask you to meet with a dietician who can suggest ways to lower your protein intake while still eating a healthy diet.

The main goal of treatment is to protect your kidneys from going into end-stage kidney failure. If your kidneys cannot keep up with waste and fluid clearance on their own and complete or near-complete kidney failure is developed, life-long dialysis or kidney transplant may be required.


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  1. Does kidney disease run in families?
The leading causes of kidney failure are diabetes and high blood pressure.  These often run in families.
  2. What changes in diet can help with kidney disease?
Cutting back salt intake is an important dietary change, since this helps control blood pressure. Eating the right amount of protein is also important, because excess protein makes your kidneys work harder. Eating enough, but not too much, protein may help protect your kidneys. Depending on the specific type and severity of kidney disease, your doctor may make specific recommendations with regard to your diet, and he/she may also refer you to a dietician.
  3. Why is smoking bad for the kidneys?
Smoking increases a person’s risk for kidney cancer, but it also hurts your heart and blood vessels. This damage can cause high blood pressure. High blood pressure is the second leading cause of kidney failure. If a person already has kidney disease, smoking can worsen the condition more quickly.