Detection methods allow you to learn more about lupus lupus nephritis

lupus nephritis

Testing for Lupus Nephritis

There is a wide range of tests that can determine how the kidney is affected.

Blood: BUN (normally<20) and creatinine (Cr; normally <1 in average woman; it may be higher in muscular men as it reflects muscle mass). Also albumin (normal>3.5) which may be decreased due to loss of protein in the urine.
Electrolytes: sodium, potassium, bicarbonate
Creatinine clearance: Calculated by using creatinine, age, race, gender. Normally 80-120 ml/min/1.73m2
Urine analysis: Normally 0-trace protein, no red and white blood cells (<5 RBC, <5 WBC)
24-h urine protein: (creatinine is also measured to assess whether collection was performed properly): normally <300mg/24h. In lupus by definition>500 mg/24h.
Spot urine protein/creatinine ratio: Normally <300 mg/24h. It may vary depending on the timing of collection: best to test second urine of the day
Renal ultrasound: size of kidneys and consistency of kidney tissue
Kidney biopsy
Other Important Tests:

1. Serology:

C3 (normally>80), when disease is active, it is usually low
C4 (normally>18), when disease is active, it is usually low
Anti-dsDNA (normal is 0), when disease is active, it is usually high
Antiphospolipid antibodies (anticardiolipin antibodies IgG, IgM, IgA, and lupus anticoagulant). This might determine whether blood thinners are needed
2. Bone tests:

Blood level of 25-OH-Vitamin D (normal >30 ng/ml)
Blood level of intact parathyroid hormone (iPTH; it is usually high in advanced kidney disease or with low 25-OH-Vitamin D levels)
Bone mineral density test (to check for osteoporosis)
3. Fasting lipids: High in nephrotic syndrome

4. Fasting blood sugar: Diabetes or other complications of steroids

5. Hemoglobin (HB): Anemia might be due to the inflammation, blood loss, hemolysis, or advanced kidney disease.

6. White blood cells: Low due to the disease or therapy. Increased risk of infection.

7. Platelets (PLT): Low due to the disease or therapy. Increased risk of bleeding.

8. Purified protein derivative (PPD) test for latent tuberculosis (TB)

9. Hepatitis C, Hepatitis B, HIV

OUTCOME INDICATORS OF CLINICAL TRIALS IN LUPUS NEPHRITIS
The incidence of renal failure associated with different treatments, as indicated by doubling of baseline serum creatinine level and/or end-stage renal failure, is commonly used as the principal end point of studies. In accordance with the progressive nature of renal function deterioration, it has been shown that prolonged follow-up exceeding 5 years is required to discern different treatment outcomes4. While these end points have obvious clinical relevance, it is imperative to note that the ultimate renal outcome is also under the influence of factors other than immunosuppressive efficacy. These modulating factors include the extent of irreversible renal parenchymal damage before and after induction therapy, blood pressure control, and the number and severity of subsequent nephritic relapses, which also relate to the efficacy of maintenance immunosuppression. Therefore, while long-term renal survival is the ultimate aim of clinical management, it is actually a composite end point subject to the influence of multiple confounding factors.

Prompt induction of remission is the major short-term objective of immunosuppressive treatment in severe lupus nephritis. The definition of remission varies between investigators, and commonly adopted criteria include a significant reduction of proteinuria, reversal of renal failure or preservation of baseline renal function, and improvement of serologic parameters such as the titre of anti-DNA antibodies and complement components. It should be noted, however, that the lack of improvements in proteinuria or renal function after treatment may be due to delayed treatment and irreversible scarring rather than inadequate immunosuppressive potency. The efficacy of immunosuppressive treatment per se is evident from abatement of serologic activity, which usually precedes end-organ manifestations. Immunologic remission is prerequisite to interruption of the damaging inflammatory processes. Prompt induction of remission is, thus, essential to the preservation of a critical renal mass, and the prevention of progressive renal failure2.

Therapy of Lupus Nephritis
In proliferative lupus nephritis (severe class III or class IV), aggressive immunosuppressive therapy is required without delay to “calm down” the overactive immune system. This is called induction therapy, as it aims to induce remission. There are many types of induction therapy, but typically all require a high dose of glucocorticoids (such as Medrol or Prednisone) plus one of the following:

Chemotherapy (IV cyclophosphamide every month for six months)
Oral Cellcept (mycophenolic acid)
After about six months of induction therapy and hopefully a good response or remission of the disease, we apply maintenance of remission therapy to maintain remission and avoid a new flare of the nephritis. In this case we typically use only a low dose of glucocorticoids, or none at all, plus one of the following options:

Oral Cellcept (mycophenolic acid)
Oral Imuran (azathioprine)
For both induction and maintenance therapies, patients may consider enrolling in clinical trials of new promising therapeutic agents. This is a consideration since available conventional therapies at present are not optimal with regard to either efficacy or safety.

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you more detailed understanding of lupus nephritis

lupus nephritis

Systemic lupus erythematosus (SLE), or lupus, is an autoimmune disease that occurs when the body's immune system mistakenly attacks its own tissues. Some symptoms include rashes, joint pain, and fatigue.

Lupus nephritis is histologically evident in most patients with systemic lupus erythematosus (SLE), even those without clinical manifestations of renal disease. Evaluating renal function in SLE patients is important because early detection and treatment of renal involvement can significantly improve renal outcome.

Signs and symptoms
Patients with lupus nephritis may report the following:

Other symptoms of active SLE (eg, fatigue, fever, rash, arthritis, serositis, or central nervous system [CNS] disease); these are more common with focal proliferative and diffuse proliferative lupus nephritis
Asymptomatic lupus nephritis – During regular follow-up, laboratory abnormalities suggest active lupus nephritis; this is more typical of mesangial or membranous lupus nephritis
Active nephritis – Peripheral edema secondary to hypertension or hypoalbuminemia; extreme peripheral edema is more common with diffuse or membranous lupus nephritis
Diffuse lupus nephritis – Headache, dizziness, visual disturbances, or signs of cardiac decompensation
Physical findings may include the following:

Focal and diffuse lupus nephritis – Generalized active SLE with the presence of a rash, oral or nasal ulcers, synovitis, or serositis; signs of active nephritis
Active lupus nephritis – Hypertension, peripheral edema, and, occasionally, cardiac decompensation
Membranous lupus nephritis – Peripheral edema, ascites, and pleural and pericardial effusions without hypertension
See Presentation for more detail.

Diagnosis
Laboratory tests to evaluate renal function in SLE patients include the following:

Blood urea nitrogen (BUN) testing
Serum creatinine assessment
Urinalysis (to check for protein, red blood cells [RBCs], and cellular casts)
Spot urine test for creatinine and protein concentration
24-hour urine test for creatinine clearance and protein excretion

Lupus nephritis is staged according to the classification revised by the International Society of Nephrology (ISN) and the Renal Pathology Society (RPS) in 2003, as follows:

Class I – Minimal mesangial lupus nephritis
Class II – Mesangial proliferative lupus nephritis
Class III – Focal lupus nephritis (active and chronic; proliferative and sclerosing)
Class IV – Diffuse lupus nephritis (active and chronic; proliferative and sclerosing; segmental and global)
Class V – Membranous lupus nephritis
Class VI – Advanced sclerosis lupus nephritis
See Workup for more detail.

Management
The principal goal of therapy in lupus nephritis is to normalize renal function or, at least, to prevent the progressive loss of renal function. Therapy differs, depending on the pathologic lesion.

Key points of American College of Rheumatology guidelines for managing lupus nephritis are as follows:

Patients with clinical evidence of active, previously untreated lupus nephritis should have a renal biopsy to classify the disease according to ISN/RPS criteria
All patients with lupus nephritis should receive background therapy with hydroxychloroquine, unless contraindicated
Glucocorticoids plus either cyclophosphamide intravenously or mycophenolate mofetil orally should be administered to patients with class III/IV disease; patients with class I/II nephritis do not require immunosuppressive therapy
Angiotensin-converting enzyme inhibitors or angiotensin-receptor blockers should be administered if proteinuria reaches or exceeds 0.5 g/day
Blood pressure should be maintained at or below 130/80 mm Hg
Patients with class V lupus nephritis are generally treated with prednisone for 1-3 months, followed by tapering for 1-2 years if a response occurs. If no response occurs, the drug is discontinued. Immunosuppressive drugs are generally not used unless renal function worsens or a proliferative component is present on renal biopsy samples.

About half the people who have systemic lupus erythematosus develop some form of kidney inflammation, called lupus nephritis. This inflammation can lead to kidney failure, but the course of the lupus and the pattern of its effects on the kidneys is quite variable and hard to predict.

According to the guidelines, a kidney biopsy is a consideration in all people with lupus who show signs of active kidney involvement.

"With earlier diagnosis and treatment, we really minimize the damage caused by lupus nephritis," says Joan T. Merrill, MD. She is the medical director of the Lupus Foundation of America and one of the authors of the new set of guidelines.

This is important as early kidney involvement is often silent, says Merrill. "Doctors should be watching the urine and seeing if there is any evidence of kidney disease. Theoretically, we should be able to pick up kidney involvement before it gets symptomatic." Merrill is also a professor of medicine at the University of Oklahoma Health Sciences Center in Oklahoma City.

Biopsy is the best way to identify kidney disease early, says Sandra C. Raymond, the president and CEO of the Lupus Foundation of America in Washington D.C. "It is the quintessential diagnosis tool for lupus nephritis. They can tell whether it is lupus or not that is causing the symptoms."

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How Does Diabetes Cause Kidney Disease?

Diabetic nephropathy

Kidneys are remarkable organs. Inside them are millions of tiny blood vessels that act as filters. Their job is to remove waste products from the blood.

Nephropathy means kidney disease or damage. Diabetic nephropathy is damage to your kidneys caused by diabetes. In severe cases it can lead to kidney failure. But not everyone with diabetes has kidney damage.

Sometimes this filtering system breaks down. Diabetes can damage the kidneys and cause them to fail. Failing kidneys lose their ability to filter out waste products, resulting in kidney disease.

How Does Diabetes Cause Kidney Disease?

When our bodies digest the protein we eat, the process creates waste products. In the kidneys, millions of tiny blood vessels (capillaries) with even tinier holes in them act as filters. As blood flows through the blood vessels, small molecules such as waste products squeeze through the holes. These waste products become part of the urine. Useful substances, such as protein and red blood cells, are too big to pass through the holes in the filter and stay in the blood.

Diabetes can damage this system. High levels of blood sugar make the kidneys filter too much blood. All this extra work is hard on the filters. After many years, they start to leak and useful protein is lost in the urine. Having small amounts of protein in the urine is called microalbuminuria.

When kidney disease is diagnosed early, during microalbuminuria, several treatments may keep kidney disease from getting worse. Having larger amounts of protein in the urine is called macroalbuminuria. When kidney disease is caught later during macroalbuminuria, end-stage renal disease, or ESRD, usually follows.

Diagnosing Diabetic Nephropathy

Screening for diabetic nephropathy should start within five years of a diagnosis of type 1 diabetes, or at the onset of puberty, whichever comes first. Screening for diabetic nephropathy in people with type 2 diabetes should take place within one year of diagnosis. All people with diabetes should then be screened annually, particularly after microalbuminuria has been detected.

Diabetic nephropathy and microalbuminuria are best diagnosed with a urine sample. It is important to avoid urine testing during an ongoing urinary tract infection or another acute illness, after strenuous exercise, or with uncontrolled high blood pressure or heart failure. Any of these conditions can cause blood and albumin to show up in the urine, resulting in an inaccurate measurement.

Treatment of Diabetic Nephropathy

The first line of defense against diabetic nephropathy is a healthy lifestyle, including a low-fat diet, light-to-moderate exercise regimen, smoking cessation, and avoiding excessive alcohol consumption in an effort to keep blood sugar levels in check and reduce blood pressure.

Albuminuria can be reversed by taking certain blood pressure medications, such as angiotensin-converting enzyme (ACE) inhibitors and angiotensin receptor blockers, which are particularly beneficial for both lowering blood pressure and protecting the kidneys in people with diabetes. A blood pressure under 130/80 mmHg should be targeted by people with diabetes. Reaching this goal often requires taking more than one blood pressure medication.

Another important factor in managing diabetic nephropathy is to keep blood sugars in check using insulin and possibly other medications as well. The target A1C level (a measure of average blood sugar levels during the last few months) for a patient with diabetic nephropathy is less than 7%.

Along with managing blood pressure and blood sugars, patients with diabetic nephropathy also benefit from lowering cholesterol and preventing obesity. There is some evidence that reducing protein in the diet will help prevent the progression of kidney disease. There is, however, some controversy regarding this theory.

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Treatment and prevention of diabetic nephropathy

Diabetic nephropathy

Diabetic nephropathy is treated with medicines that lower blood pressure and protect the kidneys. These medicines may slow down kidney damage and are started as soon as any amount of protein is found in the urine (microalbuminuria). The use of these medicines before nephropathy occurs may also help prevent nephropathy in people who have normal blood pressure.

Diabetic nephropathy is the leading cause of chronic kidney disease in patients starting renal replacement therapy (1) and is associated with increased cardiovascular mortality (2). Diabetic nephropathy has been classically defined by the presence of proteinuria >0.5 g/24 h. This stage has been referred to as overt nephropathy, clinical nephropathy, proteinuria, or macroalbuminuria. In the early 1980s, seminal studies from Europe revealed that small amounts of albumin in the urine, not usually detected by conventional methods, were predictive of the later development of proteinuria in type 1 (3–5) and type 2 (6) diabetic patients. This stage of renal involvement was termed microalbuminuria or incipient nephropathy.

If you have high blood pressure, two or more medicines may be needed to lower your blood pressure enough to protect the kidneys. Medicines are added one at a time as needed.

If you take other medicines, avoid ones that damage or stress the kidneys, especially nonsteroidal anti-inflammatory drugs (NSAIDs). NSAIDs include ibuprofen and naproxen.

Diabetic nephropathy has been didactically categorized into stages based on the values of urinary albumin excretion (UAE): microalbuminuria and macroalbuminuria. The cutoff values adopted by the American Diabetes Association (14) (timed, 24-h, and spot urine collection) for the diagnosis of micro- and macroalbuminuria, as well as the main clinical features of each stage, are depicted in Table 1. There is accumulating evidence suggesting that the risk for developing diabetic nephropathy (15–18) and cardiovascular disease (19,20) starts when UAE values are still within the normoalbuminuric range. Progression to micro- or macroalbuminuria was more frequent in patients with type 2 diabetes with baseline UAE above the median (2.5 mg/24 h) (15). After 10 years of follow-up, the risk of diabetic nephropathy was 29 times greater in patients with type 2 diabetes with UAE values >10 μg/min (16). The same was true for patients with type 1 diabetes (17). This favors the concept that the risk associated with UAE is a continuum, as is the case with blood pressure levels (21). Possibly, values of UAE lower than those currently used for microalbuminuria diagnosis should be established.

It is also important to keep your blood sugar within your target range. Maintaining blood sugar levels within your target range prevents damage to the small blood vessels in the kidneys.

Limiting the amount of salt in your diet can help keep your high blood pressure from getting worse. You may also want to restrict the amount of protein in your diet. If diabetes has affected your kidneys, limiting how much protein you eat may help you preserve kidney function. Talk to your doctor or dietitian about how much protein is best for you.

Initial treatment
Medicines that are used to treat diabetic nephropathy are also used to control blood pressure. If you have a very small amount of protein in your urine, these medicines may reverse the kidney damage. Medicines used for initial treatment of diabetic nephropathy include:

Angiotensin-converting enzyme (ACE) inhibitors, such as captopril, enalapril, lisinopril, and ramipril. ACE inhibitors can lower the amount of protein being lost in the urine. Also, they may reduce your risk of heart and blood vessel (cardiovascular) disease.
Angiotensin II receptor blockers (ARBs), such as candesartan cilexetil, irbesartan, losartan potassium, and telmisartan. You may be given both an ACE inhibitor and an ARB. The combination of these medicines may provide greater protection for your kidneys than either medicine alone.
If you also have high blood pressure, two or more medicines may be needed to lower your blood pressure enough to protect your kidneys. Medicines are added one at a time as needed.

If you take other medicines, avoid ones that damage or stress the kidneys, especially nonsteroidal anti-inflammatory drugs (NSAIDs).

It is also important to keep your blood sugar within your target range to prevent damage to the small blood vessels in the kidneys.

Ongoing treatment
As diabetic nephropathy progresses, blood pressure usually rises, making it necessary to add more medicine to control blood pressure.

Your doctor may advise you to take the following medicines that lower blood pressure. You may need to take different combinations of these medicines to best control your blood pressure. By lowering your blood pressure, you may reduce your risk of kidney damage. Medicines include:

A combination of angiotensin-converting enzyme (ACE) inhibitors and angiotensin II receptor blockers (ARBs). A combination of these medicines may be more effective in controlling blood pressure than either used alone.

Calcium channel blockers, which lower blood pressure by making it easier for blood to flow through the vessels. Examples include amlodipine, diltiazem, or verapamil.
Diuretics. Medicines such as chlorthalidone, hydrochlorothiazide, or spironolactone help lower blood pressure by removing sodium and water from the body.

Beta-blockers lower blood pressure by slowing down your heartbeat and reducing the amount of blood pumped with each heartbeat. Examples include atenolol, carvedilol, or metoprolol.

Continue to avoid other medicines that may damage or stress the kidneys, especially nonsteroidal anti-inflammatory drugs (NSAIDs). And it is still important to keep your blood sugar within your target range, eat healthy foods, get regular exercise, and not smoke.

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Diabetes, a serious threat to people's daily lives

Diabetes

Diabetic kidney disease is a complication that occurs in some people with diabetes. It can progress to kidney failure in some cases. Treatment aims to prevent or delay the progression of the disease. Also, it aims to reduce the risk of developing cardiovascular diseases such as heart attack and stroke which are much more common than average in people with this disease.

Diabetes is a disease in which your blood glucose, or blood sugar, levels are too high. Glucose comes from the foods you eat. Insulin is a hormone that helps the glucose get into your cells to give them energy. With type 1 diabetes, your body does not make insulin. With type 2 diabetes, the more common type, your body does not make or use insulin well. Without enough insulin, the glucose stays in your blood. You can also have prediabetes. This means that your blood sugar is higher than normal but not high enough to be called diabetes. Having prediabetes puts you at a higher risk of getting type 2 diabetes.

Over time, having too much glucose in your blood can cause serious problems. It can damage your eyes, kidneys, and nerves. Diabetes can also cause heart disease, stroke and even the need to remove a limb. Pregnant women can also get diabetes, called gestational diabetes.

Gestational Diabetes
This type affects females during pregnancy. Some women have very high levels of glucose in their blood, and their bodies are unable to produce enough insulin to transport all of the glucose into their cells, resulting in progressively rising levels of glucose.

Diagnosis of gestational diabetes is made during pregnancy.

Fast facts on diabetes
Here are some key points about diabetes. More detail and supporting information is in the main article.
Diabetes, describes a group of metabolic diseases in which the person has high blood glucose because insulin production is inadequate, or because the body's cells do not respond properly to insulin, or both.
In 2013 it was estimated that over 382 million people throughout the world had diabetes (Williams textbook of endocrinology).
Type 1 Diabetes - the body does not produce insulin. Approximately 10% of all diabetes cases are type 1.
Type 2 Diabetes - the body does not produce enough insulin for proper function. Approximately 90% of all cases of diabetes worldwide are of this type.
Gestational Diabetes - this type affects females during pregnancy.
The most common diabetes symptoms include frequent urination, intense thirst and hunger, weight gain, unusual weight loss, fatigue, cuts and bruises that do not heal, male sexual dysfunction, numbness and tingling in hands and feet.
If you have Type 1 and follow a healthy eating plan, do adequate exercise, and take insulin, you can lead a normal life.
Type 2 patients need to eat healthily, be physically active, and test their blood glucose. They may also need to take oral medication, and/or insulin to control blood glucose levels.
As the risk of cardiovascular disease is much higher for a diabetic, it is crucial that blood pressure and cholesterol levels are monitored regularly.
As smoking might have a serious effect on cardiovascular health, diabetics should stop smoking.
Hypoglycemia - low blood glucose - can have a bad effect on the patient. Hyperglycemia - when blood glucose is too high - can also have a bad effect on the patient.
There are three types of diabetes:

1) Type 1 Diabetes
The body does not produce insulin. Some people may refer to this type as insulin-dependent diabetes, juvenile diabetes, or early-onset diabetes. People usually develop type 1 diabetes before their 40th year, often in early adulthood or teenage years.

Type 1 diabetes is nowhere near as common as type 2 diabetes. Approximately 10% of all diabetes cases are type 1.

Patients with type 1 diabetes will need to take insulin injections for the rest of their life. They must also ensure proper blood-glucose levels by carrying out regular blood tests and following a special diet.

Between 2001 and 2009, the prevalence of type 1 diabetes among the under 20s in the USA rose 23%, according to SEARCH for Diabetes in Youth data issued by the CDC (Centers for Disease Control and Prevention). (Link to article)

2) Type 2 Diabetes
The body does not produce enough insulin for proper function, or the cells in the body do not react to insulin (insulin resistance).

Approximately 90% of all cases of diabetes worldwide are of this type.

Diabetes patient measuring glucose level in bloodMeasuring the glucose level in blood
Some people may be able to control their type 2 diabetes symptoms by losing weight, following a healthy diet, doing plenty of exercise, and monitoring their blood glucose levels. However, type 2 diabetes is typically a progressive disease - it gradually gets worse - and the patient will probably end up have to take insulin, usually in tablet form.

Overweight and obese people have a much higher risk of developing type 2 diabetes compared to those with a healthy body weight. People with a lot of visceral fat, also known as central obesity, belly fat, or abdominal obesity, are especially at risk. Being overweight/obese causes the body to release chemicals that can destabilize the body's cardiovascular and metabolic systems.

Being overweight, physically inactive and eating the wrong foods all contribute to our risk of developing type 2 diabetes. Drinking just one can of (non-diet) soda per day can raise our risk of developing type 2 diabetes by 22%, researchers from Imperial College London reported in the journal Diabetologia. The scientists believe that the impact of sugary soft drinks on diabetes risk may be a direct one, rather than simply an influence on body weight.

The risk of developing type 2 diabetes is also greater as we get older. Experts are not completely sure why, but say that as we age we tend to put on weight and become less physically active. Those with a close relative who had/had type 2 diabetes, people of Middle Eastern, African, or South Asian descent also have a higher risk of developing the disease.

Men whose testosterone levels are low have been found to have a higher risk of developing type 2 diabetes. Researchers from the University of Edinburgh, Scotland, say that low testosterone levels are linked to insulin resistance. (Link to article)

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Diagnosis and treatment of glomerulonephritis

Glomerulonephritis

Glomerulonephritis is a disease of the kidneys in which there is inflammation of the filtering units, called glomeruli. This inflammation can cause protein and red blood cells to leak into the urine while toxins normally removed by the kidney are retained in the body. Kidney failure develops when the kidney becomes less effective at filtering out waste products, water and salt from the blood.

There are many types and causes of glomerulonephritis.

Prior infection: For example, after a streptococcal infection (such as strep throat), kidney failure may develop with associated problems of high blood pressure, dark urine, and swelling in the legs. Glomerulonephritis following streptococcal bacterial infection is among the most common types of post-infectious disease, especially among children.
Autoimmune: With conditions such as systemic lupus erythematosus (SLE) or blood vessel inflammation (vasculitis), the body's immune system mistakenly attacks healthy tissue. When the kidney's filtering system is the target, glomerulonephritis may develop.
Antibody-mediated: The most common type is called IgA nephropathy. While this can be associated with liver disease, celiac disease or HIV infection, many cases are of unknown cause. Immunoglobulin A, an antibody that normally helps fight off infection, is deposited in the kidney, leading to hematuria (blood in the urine) but less commonly more serious problems.
Membranous glomerulonephritis: This condition may develop as part of lupus or on its own. The hallmark of this type of kidney disease is the leakage of protein into the urine.
Rapidly progressive glomerulonephritis: This condition may be diagnosed when there is kidney inflammation and loss of kidney function over weeks to months. Triggers include infections, autoimmune disease, and certain types of antibody-mediated kidney disease.
Idiopathic: When glomerulonephritis develops for no apparent reason it is called "idiopathic." It's possible that an undetected or undiagnosed infection or a hereditary cause led to kidney inflammation and damage.
Symptoms

If glomerulonephritis is mild, it may not cause any symptoms. In that case, the disease may be discovered only if protein or blood is found in the urine during a routine test. In other people, the first clue can be the development of high blood pressure. If symptoms appear, they can include swelling around the feet, ankles, lower legs, and eyes, reduced urination and dark urine (due to the presence of red blood cells in the urine).

High levels of protein in the urine can cause the urine to appear foamy. If severely elevated blood pressure develops, some people will have headaches (although most people with high blood pressure have no symptoms and most headaches are unrelated to blood pressure). Fatigue, nausea and tremulousness are other common symptoms of kidney failure due to glomerulonephritis. In severe cases, confusion or coma may develop.

Diagnosis

Your doctor will ask you about symptoms of a prior infection, family history, or symptoms of conditions that can affect the kidneys. For example, joint pain and rash are the most common symptoms of lupus. Your doctor will ask how often you are urinating, how much urine you are producing and the color of the urine. To check for a history of swelling, your doctor may ask whether you've noticed puffiness around your eyes, unusual tightness in your shoes or waistband or a feeling of heaviness in your legs or ankles.

During your physical examination, your doctor will measure your blood pressure, weigh you to check for weight gain resulting from water retention, and check for swelling in your legs or elsewhere. A complete physical examination is important to look for evidence of other organ involvement such as arthritis or rash.

To confirm the diagnosis of glomerulonephritis, your doctor will evaluate your kidney function through blood tests and an analysis of the urine (called a urinalysis) that detects blood, protein or signs of infection. You also may need specialized blood testing to check for specific autoimmune disease. A kidney biopsy, in which a tiny piece of kidney tissue is removed and examined in a laboratory, is the most helpful test when glomerulonephritis is suspected.

Expected Duration

How long glomerulonephritis lasts depends on its cause and on the severity of kidney damage. When glomerulonephritis follows an infection, the problem usually goes away within weeks to months. In other cases, glomerulonephritis becomes a chronic (long-lasting) condition that lasts for years and eventually can lead to kidney failure.

Treatment

When glomerulonephritis is caused by an infection, the first step in treatment is to eliminate the infection. If bacteria caused the infection, antibiotics may be given. However, children who develop the disease following a streptococcal infection often recover without any specific treatment.

When glomerulonephritis has slowed the amount of urine a person is producing, he or she may be given medications called diuretics, which help the body to rid itself of excess water and salt by producing more urine. More severe forms of the disease are treated with medications to control high blood pressure, as well as changes in diet to reduce the work of the kidneys. Some people with severe glomerulonephritis may be treated with medications called immunosuppressive drugs, which decrease the activity of the immune system. Such medications include azathioprine (Imuran), corticosteroids (Prednisone, Methylprednisolone), cyclophosphamide (Cytoxan), rituximab (Rituxan) or mycophenolate mofetil (CellCept). Plasma exchange, a procedure during which substances thought to cause inflammation and kidney damage are removed from the blood, can be helpful in certain types of autoimmune or antibody-mediated glomerulonephritis. When glomerulonephritis progresses to severe, irreversible renal failure, treatment options include dialysis or a kidney transplant.

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If your child had chronic kidney disease do not worry below should tell you what to do

chronic kidney disease

How can chronic kidney disease (CKD) affect children and their families?
How can parents and other adults help children with chronic kidney disease in daily life?
Who can help families deal with issues related to chronic kidney disease in children?
Eating, Diet, and Nutrition
Points to Remember
Hope through Research
For More Information
How can chronic kidney disease (CKD) affect children and their families?
The lives of children with serious and long-lasting conditions such as CKD are affected in many ways. CKD is any condition that causes reduced kidney function over an extended period of time. Children with CKD may have a negative self-image and may have relationship problems with family members due to the stress of living with a chronic disease. The condition can lead to behavior problems and make participating in school and extracurricular activities more difficult. CKD can cause learning problems because the buildup of wastes in the body can slow down nerve and brain function. Children with CKD may have trouble concentrating and may develop language and motor skills more slowly than their peers. The most severe problems occur when CKD is present starting early in infancy.
CKD that leads to kidney failure—described as end-stage kidney disease or ESRD when treated with a kidney transplant or blood-filtering treatments called dialysis—can increase these challenges. Fortunately, a kidney transplant can reverse or improve most of these problems. Dialysis can also improve or correct these problems. Most children with CKD who receive appropriate treatment can attend school, graduate from high school, and go on to college or vocational school. However, families of children with CKD or kidney failure need to recognize that these children may need additional guidance and understanding.

How can parents and other adults help children with chronic kidney disease in daily life?
Parents and other adults can help children with CKD fit in at school, deal with low self-esteem, make friends, be physically active, and follow their treatment regimen. As children with CKD approach adulthood, they may need help with preparing to enter the workforce.
Attending School
School attendance is vital in helping children with CKD lead the best life possible. Many people are unaware of how CKD affects children. School administrators, teachers, and classmates should receive education and information about the effects of CKD.
Children with kidney failure may miss school each week because of dialysis and medical appointments. These absences can compound the learning problems many children with CKD face. Parents or guardians should make every effort to schedule treatments outside of school hours.

Making Friends
Children with CKD may have trouble fitting in with children their own age because of their small stature or delayed mental development. For children who have had a transplant, the side effects—such as a full face, weight gain, acne, or facial hair—of some of the medications they take may make it harder to make friends and may also lower self-esteem. Participating in regular classroom and extracurricular activities may help children improve their social skills. Summer camps and recreational programs for children with special needs can be a good place to make new friends.
Participating in Physical Activities and Sports
Children with CKD should be encouraged to participate in physical activities, including exercise and sports. In general, exercise has physical and psychological benefits. Parents or guardians may feel protective of children with CKD; however, they should not try to limit activities unless instructed to by a health care provider. Some children may even need to be encouraged to get outside and play. Parents or guardians should talk with their child’s health care provider about the right activity level and appropriate sports for their child.

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Symptoms of chronic kidney disease

chronic kidney disease

This topic provides information about chronic kidney disease. If you are looking for information about sudden kidney failure, see the topic Acute Renal Failure.

Having chronic kidney disease means that for some time your kidneys have not been working the way they should. Your kidneys have the important job of filtering your blood. They remove waste products and extra fluid and flush them from your body as urine. When your kidneys don't work right, wastes build up in your blood and make you sick.

Chronic kidney disease may seem to have come on suddenly. But it has been happening bit by bit for many years as a result of damage to your kidneys.

Each of your kidneys has about a million tiny filters, called nephrons. If nephrons are damaged, they stop working. For a while, healthy nephrons can take on the extra work. But if the damage continues, more and more nephrons shut down. After a certain point, the nephrons that are left cannot filter your blood well enough to keep you healthy.

One way to measure how well your kidneys are working is to figure out your glomerular filtration rate (GFR). The GFR is usually calculated using results from your blood creatinine (say "kree-AT-uh-neen") test. Then the stage of kidney disease is figured out using the GFR. There are five stages of kidney disease, from kidney damage with normal GFR to kidney failure.

There are things you can do to slow or stop the damage to your kidneys. Taking medicines and making some lifestyle changes can help you manage your disease and feel better.

Signs and symptoms of kidney disease may include:

Nausea
Vomiting
Loss of appetite
Fatigue and weakness
Sleep problems
Changes in urine output
Decreased mental sharpness
Muscle twitches and cramps
Hiccups
Swelling of feet and ankles
Persistent itching
Chest pain, if fluid builds up around the lining of the heart
Shortness of breath, if fluid builds up in the lungs
High blood pressure (hypertension) that's difficult to control
Signs and symptoms of kidney disease are often nonspecific, meaning they can also be caused by other illnesses. And because your kidneys are highly adaptable and able to compensate for lost function, signs and symptoms may not appear until irreversible damage has occurred.

Chronic kidney disease is also called chronic renal failure or chronic renal insufficiency.

Chronic kidney disease is caused by damage to the kidneys. The most common causes of this damage are:

High blood pressure.
High blood sugar (diabetes).
Other things that can lead to chronic kidney disease include:

Kidney diseases and infections, such as polycystic kidney disease, pyelonephritis, and glomerulonephritis, or a kidney problem you were born with.
A narrowed or blocked renal artery. The renal artery carries blood to the kidneys.
Long-term use of medicines that can damage the kidneys. Examples include nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen (Advil) and celecoxib (Celebrex).
You may start to have symptoms only a few months after your kidneys begin to fail. But most people don't have symptoms early on. In fact, many don't have symptoms for as long as 30 years or more. This is called the "silent" phase of the disease.

How well your kidneys work is called kidney function. As your kidney function gets worse, you may:Consult our website or contact our mailbox to provide you with more knowledge of kidney disease

Polycystic kidney disease precautions

Polycystic kidney disease 

In fact, the PKD pathogen is the gene loss. And the APKD is because of the chromosome 16 gene loss, chromosome 4 gene loss occasionally. Therefore, the chromosome loss of single parent will make children suffer the disease with possibility of 50%. Whereas, for the infantile polycystic kidney, it belongs to autosomal recessive inheritance, when parents have the disease gene modification, then cause their children have this disease.
Moreover, the diet has big influence on the treatment and recovery of PKD. If patients develop a bad diet habit, it will make the disease worse. So following good diet can benefit the patients in some extent. Here is patients need to pay attention to.
First, high protein food. In order to prevent the metabolites synthesis in the body, and relieve the renal discharging ability, low protein diet is suggested, such as beans, tofu and other bean products.
Second, visceral food. Due to many toxins will deposite in liver, kidney when killing animals, which will enhance burden on kidney and make the disease worse. So avoid eating visceral food.
Third, alcoholic beverage, alcohols, especially the white spirit can stimulate polycystic protein activity and speed up the cyst development, so the PKD patients should quit alcoholic beverage.
Fourth, No fermentation products. The fermentation products here indicate the mildew fermentation food, like fermented bean curd, rotten eggs.
Fifth, coffee, chocolate are not permitted. because the hormone contained in coffee can damage the kidney function greatly. Coffee contains tannin and antioxidants, which are good for the heart and arteries, but for kidney disease patients, coffee can induce cardiovascular disease, increase the burden for the kidneys.
Sixth, the patients can eat more iron-rich fruits and vegetables, for example, carrot. In addition, high vitamin fruits and vegetables are advisable.
Seventh, the patients can eat food which has diuresis effect.
Eighth, in daily life, the patients need to avoid overwork, and the usage of nephrotoxic drugs.
Now that many cysts has developed in kidney, besides, some PKD genes can’t be changed, the most important is finding a method to remove cysts out, and make it rebound, at last, recover normal kidney functions.

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Treatment of chronic glomerulonephritis

Treating glomerulonephritis

Treating glomerulonephritis
In some cases, glomerulonephritis may be so mild that treatment isn’t necessary. In these cases, a doctor may simply continue to monitor the situation. Severe, acute glomerulonephritis caused by an infection of some kind may be treated with diet changes and a combination of medicines, including antibiotics to treat the infection, blood pressure medicines and immunosuppressant drugs.

Treatment varies depending on the cause of the disorder, and the type and severity of symptoms. The primary treatment goal is control of symptoms. High blood pressure may be difficult to control, and it is generally the most important aspect of treatment. Various medications may be used to attempt to control high blood pressure.

Corticosteroids, immunosuppressives, or other medications may be used to treat some of the causes of chronic glomerulonephritis.

Treatment for chronic nephritis depends on the type and cause of the condition. It aims at reducing inflammation, relieving the symptoms and repairing the damaged kidney tissues, as well as improving kidney function. Based on the aim, here are several treatment options are suggested.

Chinese Herbal Medicine. It uses specific herbs which help repair the damaged kidney tissues and improve kidney function. In addition, patients usually get the additional effects for the symptoms, because Chinese herbal medicine offers holistic effects.

Immunotherapy. It is a biological therapy which helps use the immune system to control the inflammation on kidneys. This helps delay the progression of Nephritis.

Chronic glomerulonephritis is also treated with immunosuppressant drugs given intravenously or by mouth if the condition is caused by an autoimmune disease. Medicine may also be given to remove antibodies from the blood that could be attacking the kidneys. High blood pressure medicines such as angiotensin-converting enzyme (ACE) inhibitors and angiotensin II receptor blockers (ARBs) may also be taken to help slow the progression of glomerulonephritis. Doctors may also recommend reducing sodium, potassium and protein intake to reduce the amount of work the kidneys have to do.

About 75 percent of people with acute or chronic glomerular disease who are treated within the first few weeks or months of the disease preserve their kidney function. However, detecting the disease in the early weeks or months is often not easy because the symptoms are so mild. In many cases, the disease is not discovered until kidney failure has already begun.

A person’s ability to recover from glomerulonephritis also has to do with the cause of the disease, the person’s age and any other health conditions he or she may have. A kidney transplant may be a viable treatment option for someone with glomerulonephritis whose kidneys have failed, but the disease could return in a transplanted kidney.

Glomerulonephritis or glomerular disease is a kidney disease that can damage the kidneys and lead to end stage renal disease (ESRD) and dialysis. If you think you are at risk for glomerulonephritis or are experiencing symptoms of this disease, talk to your doctor. The earlier the disease is found, the better the chances of treating it and preserving kidney function.

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Symptoms of Chronic Glomerulonephritis

Chronic Nephritis

Chronic Nephritis: Cause, Symptoms, Treatment, Diet
Chronic nephritis refers to the inflammations that occur in the kidneys. It is a complex kidney disease.
Cause

There are many causes can contribute to chronic nephritis. The common causes for chronic nephritis, include:

- acute nephritis. If acute nephritis cannot be controlled immediately, it may develop into chronic kidney damage.

- infection. Especially in children, infection with the streptococcus bacteria may lead to an immune reaction that damages the filtering units of the kidney known as the glomeruli, causing chronic nephritis.

- Henoch-Schonlein Purpura and haemolytic-uraemic syndrome. Both of the two immune-related disease are the common cause for chronic Nephritis.

Symptoms

As the nephritis develops, some symptoms may appear to show. And if you happen to be a person with chronic nephritis, you may experience one or more of the following nephritis, such as:

High blood pressure, drowsiness, swelling, itchy skin, nausea, shortness of breath, abdominal pain, Back Pain, Flank Pain, headache, Blood in Urine, Low Urine output etc.

Symptoms of Chronic Glomerulonephritis
Blood or protein in the urine may be found on routine urinalysis
Facial [uffiness in the morning
Swelling of the legs or ankles or other parts of the body, due to fluid accumulation (edema)
Shortness of breath during exertion due to anemia
Headache or other symptoms of high blood pressure
In severe cases, symptoms of kidney failure, including fatigue; seizures; nausea and vomiting; loss of appetite; overall itching; headache; easy bruising; frequent hiccups or bleeding; and impaired vision
Increased pigmentation of the skin。

Causes of glomerulonephritis
Glomerulonephritis can be acute or chronic. With acute glomerulonephritis, symptoms come on suddenly and may be temporary or reversible. Acute glomerulonephritis can come about because of an infection such as strep throat, chickenpox or malaria. Acute glomerulonephritis caused by an infection is called post-infectious glomerulonephritis. In an acute case of glomerulonephritis, the antibodies that are created to get rid of the body’s infection begin to attack the glomeruli.

Studies show that 1 percent of children and 10 percent of adults with acute glomerular disease will develop progressive or chronic glomerular disease, which may lead to kidney failure and end stage renal disease (ESRD). People with acute glomerular disease could also develop other kidney diseases.

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Prevention and treatment of glomerulonephritis

Glomerulonephritis

Glomerulonephritis is a group of diseases that injure the part of the kidney that filters blood (called glomeruli). Other terms you may hear used are nephritis and nephrotic syndrome. When the kidney is injured, it cannot get rid of wastes and extra fluid in the body. If the illness continues, the kidneys may stop working completely, resulting in kidney failure.

Are there different types of glomerulonephritis?
Yes. There are two types of glomerulonephritis—acute and chronic. The acute form develops suddenly. You may get it after an infection in your throat or on your skin. Sometimes, you may get better on your own. Other times, your kidneys may stop working unless the right treatment is started quickly. The early symptoms of the acute disease are:

puffiness of your face in the morning
blood in your urine (or brown urine)
urinating less than usual.
You may be short of breath and cough because of extra fluid in your lungs. You may also have high blood pressure. If you have one or all of these symptoms, be sure to see your doctor right away.

The chronic form may develop silently (without symptoms) over several years. It often leads to complete kidney failure. Early signs and symptoms of the chronic form may include:

What causes acute glomerulonephritis?
The acute disease may be caused by infections such as strep throat. It may also be caused by other illnesses, including lupus, Goodpasture's syndrome, Wegener's disease, and polyarteritis nodosa. Early diagnosis and prompt treatment are important to prevent kidney failure.

What causes chronic glomerulonephritis?
Sometimes, the disease runs in the family. This kind often shows up in young men who may also have hearing loss and vision loss. Some forms are caused by changes in the immune system. However, in many cases, the cause is not known. Sometimes, you will have one acute attack of the disease and develop the chronic form years later.

How is a diagnosis of glomerulonephritis made?
The first clues are the signs and symptoms. Finding protein and blood cells in your urine is another sign. Blood tests will help the doctor tell what type of illness you have and how much it has hurt your kidneys.

1, the prevention of chronic glomerulonephritis, first of all to be positive prevention and treatment of acute nephritis, to avoid inadequate treatment, which is the main measures to prevent chronic nephritis acute conversion from.

2, reduce the thick greasy help wet injured spleen food intake, do regular diet, Paul acquired in order to raise a priori. Salt into the kidney, excessive eating salty foods can damage the kidneys, especially in times of acute nephritis, the appropriate limit salt intake.
Especially in patients with edema symptoms, you should limit the intake of salt, specific dosage limits should be based on the patient's specific condition, according to the patient's edema, blood pressure change as the basis. The daily food but also pay attention to balanced nutrition diversification, in order to enhance the body's resistance to disease.

3, to avoid damage to the kidney drugs, such as gentamicin, kanamycin, polymyxin and neomycin. Medicine such as Akebia, large doses of renal toxicity should be noted.

4, usually pay attention to prevent tired, to avoid the application of damage righteousness drugs and traditional Chinese medicines and kidney damage, especially to avoid the infringement of the wind, cold, wet, hot, poisonous evil. Timely treatment of exogenous disease and eliminate the infection of the mouth, hands, ears, throat, etc., chronic glomerulonephritis and disease prevention is important.
Chronic glomerulonephritis to prevent upper respiratory tract infection, tonsillitis, acute and chronic pharyngitis. For patients not infected with decreased immune function, commonly used Yupingfeng oral liquid, or Huang oral liquid. Infected patients should be treated in time, Western medicine commonly used penicillin, Chinese medicines Yinqiaosan, Banlangen granules, silver yellow oral solution.
Patients with high blood pressure, such as urine appear red blood cells may make use of Qi Ju Di Huang Wan or the Liver Yishenhuoxue and network of Chinese medicine. In patients with hypertension, should actively control blood pressure, renal hypertension is often heavy in winter, summer light, attention should be to adjust the dose.

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Causes chronic nephritis

Chronic glomerulonephritis is the advanced stage of a group of kidney disorders, resulting in inflammation and slowly worsening destruction of internal kidney structures

Chronic glomerulonephritis occurs when there is slow, progressive destruction of the glomeruli of the kidney, with progressive loss of kidney function. In some cases, the cause is found to be a specific attack to the body's immune system, but in most cases, the cause is unknown. Iit is generally thought that a still-unidentified abnormality of the immune system is to blame.

Damage to the glomeruli affects the kidney's ability to filter fluids and wastes properly. This leads to blood and protein in the urine.
This condition may develop after survival of the acute phase of rapidly progressive glomerulonephritis. In about one-quarter of people with chronic glomerulonephritis there is no prior history of kidney disease, and the disorder first appears as chronic kidney failure.

Glomerulonephritis is among the leading causes of chronic kidney failure and end stage kidney disease. Causes include:

Because symptoms develop gradually, the disorder may be discovered when there is an abnormal urinalysis during a routine physical or during an examination for another, unrelated disorder. It may be discovered as a cause of high blood pressure that is difficult to control.

Laboratory tests may reveal anemia or show signs of reduced kidney functioning, including azotemia. Later, signs of chronic kidney failure may be apparent, including edema .

Treatment varies depending on the cause of the disorder, and the type and severity of symptoms. The primary treatment goal is control of symptoms. High blood pressure may be difficult to control, and it is generally the most important aspect of treatment. Various medications may be used to attempt to control high blood pressure.
Corticosteroids, immunosuppressives, or other medications may be used to treat some of the causes of chronic glomerulonephritis.

Treatment for chronic nephritis depends on the type and cause of the condition. It aims at reducing inflammation, relieving the symptoms and repairing the damaged kidney tissues, as well as improving kidney function. Based on the aim, here are several treatment options are suggested.

Chinese Herbal Medicine. It uses specific herbs which help repair the damaged kidney tissues and improve kidney function. In addition, patients usually get the additional effects for the symptoms, because Chinese herbal medicine offers holistic effects.

Immunotherapy. It is a biological therapy which helps use the immune system to control the inflammation on kidneys. This helps delay the progression of Nephritis.

Diet Management

Eating habits and diet management show a very important role which patients can not ignore. Patients with chronic nephritis are suggested to take a low-phosphorus, low-protein diet.

Patients should ensure adequate carbohydrates, in patients with chronic nephritis due to limit protein intake, heat is supplied primarily by carbohydrates, dietary carbohydrate should increase to meet the needs of the body heat.

What causes IgA nephropathy?

iga nephropathy

What causes IgA nephropathy?
Anyone at any age can get IgA nephropathy although it is more common in men. Caucasians and Asians also have a higher incidence of IgA nephropathy than other ethnic groups.

It is still unknown how people develop IgA nephropathy and why IgA traps itself in the kidneys. In some cases IgA nephropathy can develop after a child or young adult has a viral infection of the upper respiratory or gastrointestinal tracts. For some people, a genetic defect may be linked to the development of IgA nephropathy.

IgA nephropathy tends to progress slowly, and in only about half of patients does it progress to end-stage renal disease within 25 years.

At present, the factors that predict an accelerated course and progression to end-stage renal disease are persistent proteinuria, elevated serum creatinine at diagnosis, persistent microscopic hematuria, poorly controlled hypertension, and extensive glomerulosclerosis or interstitial fibrosis, or both, on renal biopsy.

Needed are better diagnostic and prognostic tests and therapies that address the mechanism of the disease.

IgA nephropathy and your kidneys
Acute kidney failure or chronic kidney disease can occur due to IgA nephropathy. In some cases of IgA nephropathy, a person’s kidneys will stop functioning suddenly and then after a time will begin functioning again. For those who have IgA nephropathy that leads to chronic kidney disease, after time — years or even decades — their kidneys will slowly stop functioning. Whether there is acute kidney failure or kidney function stops after time, dialysis will be necessary. Dialysis acts as a replacement for the kidneys by filtering the waste and toxins from your blood through a dialysis machine. A kidney transplant can be considered for those who have progressed to end stage renal disease.

How do doctors diagnose IgA nephropathy?
Blood in the urine is the most common symptom for IgA nephropathy. If blood or protein is found in your urine a series of blood and urine tests may be ordered by your doctor. These tests can usually determine if the kidneys are injured and how well they are working. Large amounts of IgA in your blood can sometimes be detected, but there are no specific blood or urine tests that can always determine whether kidney injury is due to IgA nephrolpathy, or if it is due to some other condition.

A kidney biopsy may be in order if your doctor believes it is a severe case. To perform a kidney biopsy, your doctor uses a special biopsy needle to remove tiny pieces of tissue from your kidneys for examination in determining if IgA has lodged itself into the glomeruli.

iga nephropathy can not ignore him threatening the safety of people want to learn more knowledge iga nephropathy, please consult our web site ，or online contact with our experts Union

To understand the relevant knowledge of IgA nephropathy

Understanding iga nephropathy

To understand the relevant knowledge of IgA nephropathy

Because the clinical manifestation of IgA nephropathy diversity, not a pathological type, the diagnosis and treatment are not the same, and treatment may be longer. Some patients requiring renal biopsy, to confirm the diagnosis, directing treatment and judging the development of the disease, patients have basic understanding of relevant knowledge, can reduce the blind fear and strengthen cooperation with doctors.

Adequate rest and exercise

To ensure adequate sleep in patients with IgA nephropathy. Sleep in bed, have more blood flow to the kidney, conducive to the resumption of IgA nephropathy. Adult day to sleep 7 to 8 hours. Sleep environment should be quiet, before going to bed can be used warm water to soak the foot, to help sleep. Bedtime do not drink tea Coffee, do not eat food, or to sleep. Moderate exercise. Lighter to the illness or condition is stable patients, should encourage them to take part in the work and to do everything in one's power moderate exercise. Such as walking, doing exercises, Tai Chi is a good choice. But the need to pay attention to is, work or exercise should follow the progressive, moderate, easy time reasonably, avoid excessive overworked and strenuous exercise.

To adjust the diet of patients with IgA nephropathy

1. Low in salt.

Due to high blood pressure and edema, patients with IgA nephropathy should limit intake of salt and something containing high sodium. The below are common food containing high sodium in daily life:

Pickle，Cookie，Dessert，Condiment，preserved bean curd，tuber mustard

2. Low in protein.

Protein can decompose into nitrogen, which is a waste in body. If patients with IgA nephropathy eat much protein, large amounts of wastes will cause too much burden on kidneys. In this way, eating much protein leads to kidney damage.

3. Limit intake of water.

If patients with IgA nephropathy have the symptom of swelling, water or fluids should be limited. Drinking much water can aggravate edema and add more burdens to kidney, which is very harmful for kidney.

4. Low fat.

Much fat can contribute to the risk of blood viscosity or thrombus.

To make patients with IgA nephropathy easier to differentiate what can’t be eaten, the below food is diet taboos we conclude.

Meat and fish Fried food Animal livers.

5. Rich in vitamins.

Food rich in vitamins can be helpful for kidney function, and fresh vegetables and fruits contain large quantities of vitamins. Patients with IgA nephropathy should eat more vegetables and fruits.

Taste IgA in patients with chronic nephropathy appropriate is delicate, avoid alcohol and spicy food, renal damage to protein intake of dietary restrictions, the egg, milk, lean meat and other animal protein based, and oral essential amino acid agent to prevent malnutrition.

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Preventive measures IgA nephropath

 IgA nephropathy

IgA nephropathy is a disorder of the kidney. It may start with minor changes in the kidneys, but it can lead to chronic kidney disease or kidney failure.

Causes
IgA nephropathy is caused by a buildup of the IgA protein in the kidneys. IgA proteins help the body fight infections. There are more of these proteins when you have an infection like the cold or flu.

The protein buildup can damage the filters of the kidneys. These filters are needed to clean the blood as it passes through. If the filters are damaged, then the kidneys are not able to clean the blood. Minor damage to the filters will not cause any changes. Major damage will worsen your health. IgA nephropathy can also cause some blood and protein to leak into the urine.

Genetics may play a role in the buildup of IgA proteins in the kidney.

IgA nephropathy
Henoch schoenlein purpura
Symptoms
Early stages of IgA nephropathy rarely have symptoms.

The first sign of IgA nephropathy is often blood in the urine. It often occurs after an infection like a cold. Small amounts of blood in the urine may only be detected with a test. Larger amounts of blood in the urine can make the urine a pink or cola color.

Later stage symptoms may also include:Swelling of the hands and feet Repeated upper respiratory infections Fatigue Muscle pain Fever Diagnosis
Your doctor will ask about your symptoms and medical history. A physical exam will be done.

Your bodily fluids and tissues may be tested. This can be done with: Urine tests Blood tests Biopsy Treatment  There is no cure for IgA nephropathy. The goal of treatment is to slow damage to the kidneys. Your doctor will also make a plan to manage related symptoms, such as high blood pressure. Talk with your doctor about the best treatment plan for you. Treatment options include:
Medications
Depending on your symptoms and overall health, your doctor may suggest:

Medications to help control blood pressure and decrease protein loss in the urine
Cholesterol lowering medication
Corticosteroids to decrease inflammation in the body
Medications to suppress the immune system
Dietary Changes
Your doctor may recommend certain changes to your diet. The changes will depend on your overall health and your kidney function. Some changes may include:

Controlling protein in the diet by limiting or avoiding:
Most meats and dairy products
Gluten—protein found in wheat, rye, barley, and oats
Controlling salt in the diet
Dietary changes to manage blood cholesterol levels
Your doctor may also recommend certain supplements like fish oil. Talk to your doctor before starting any supplements.

Lifestyle Changes
Exercise can help with overall health. It can also help manage cholesterol and blood pressure.Don't smoke. If you smoke, quit.

Kidney Support
Dialysis takes over the job of the kidneys if they are not able to work well. It cannot cure the kidney damage, but it will help you feel better and decrease symptoms like high blood pressure.

A kidney transplant may be needed when illness has progressed and the kidneys have failed.

Treating and Preventing IgA Nephropathy

The cause of IgA nephropathy is not clear, so there are no known steps to prevent it.

Tell your doctor if you have a family history of IgA nephropathy. You and your doctor can watch for signs of the disease and manage issues like high blood pressure and cholesterol.

There is no specific treatment for IgA nephropathy. The goal is to reduce symptoms caused by the kidney's inability to work properly, and to try to avoid the problems this can cause, such as chronic renal failure.

The health care team may suggest dietary changes to reduce the amount of salt and protein intake. A registered dietitian can help draw up a healthy eating plan that takes this into account. Fish oils may be added to the diet. Corticosteroids and medications to suppress the immune system may also be used.

Hypertension (high blood pressure) may have been a warning sign of IgA nephropathy. If this is the case, it will be treated, usually with antihypertensive medications (medications for high blood pressure). Hypertension is also a complication of most kidney disorders. If blood pressure isn't already high when a person is diagnosed with IgA nephropathy, doctors will watch closely for its development. Lifestyle changes (e.g., diet, exercise, stress management) to help avoid getting high blood pressure might be recommended.
Last reviewed May 2014 by Adrienne Carmack, MD

Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.

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Iga nephropathy symptoms Profile

Iga nephropathy

IgA nephropathy is a progressive condition, and it can take decades before you experience any symptoms. Sometimes, during a routine screening your doctor may detect signs of IgA nephropathy.

In many parts of the world, IgA nephropathy is the most common form of glomerulonephritis--a disease that damages the tiny filtering units of the kidney, called glomeruli. The damage caused by IgA nephropathy results from abnormal deposits of a protein called "IgA" in the glomeruli.

IgA is a protein called an antibody that helps the body fight infections. IgA nephropathy (Berger's disease) occurs when too much of this protein is deposited in the kidneys. IgA builds up inside the small blood vessels of the kidney. Structures in the kidney called glomeruli become inflamed and damaged.

IgA nephropathy (Berger's disease) is a form of mesangial proliferative nephritis.

The disorder can appear suddenly (acute), or get worse slowly over many years (chronic glomerulonephritis).


One of the kidney's most important jobs is to filter toxic waste products from the blood, and the glomeruli play a key role in this process. As more glomeruli are damaged by the IgA protein, the kidney progressively loses its ability to clear wastes from the body. In some patients with IgA nephropathy, this loss of kidney function progresses to chronic kidney failure, which requires dialysis treatment or a kidney transplant.

What are the signs and symptoms of IgA nephropathy?
The most common sign is blood in the urine. The amount of blood may be so small that it is only visible with the aid of a microscope. Another common sign is swelling of the feet.

What causes IgA nephropathy?
The causes of IgA nephropathy are not well understood. The disease seems to cluster in certain families and in certain areas of the world. It rarely occurs in people of African heritage. These facts suggest that genetic influences may play a role in the development of the disease.

How is IgA nephropathy diagnosed?
The presence of blood or protein in the urine are a possible sign of IgA nephropathy. A blood test for serum creatinine can be used to calculate glomerular filtration rate (GFR), which tells how well your kidneys are filtering wastes from the blood. To confirm this diagnosis, it is necessary to do a biopsy. The doctor removes a small piece of tissue from the kidney and examines it under a microscope to look for the characteristic IgA deposits in the glomeruli.

How is IgA nephropathy treated?
Efforts to slow the progression of kidney damage may include limiting the amount of protein in the diet and, if present, careful control of high blood pressure through diet and medication. If these treatments are not enough after a few months, then corticosteroids, such as prednisone, may also be considered. Fish oil has also been used as a treatment. Discuss the use of any supplement and medication with your doctor. For patients who develop progressive kidney failure, treatment may consist of dialysis or a kidney transplant.

The success rate of transplants is good in these patients. Even though the IgA deposits reappear in the transplanted kidney in about half the patients within one year after the operation, the signs and symptoms of the disease remain mild. Loss of a transplanted kidney to recurrent IgA nephropathy is uncommon. The milder form of the disease seen after transplantation may be due to the use of anti-rejection drugs such as cyclosporine.

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Symptoms of lupus nephritis introduction

添加图片说明

Lupus nephritis is histologically evident in most patients with systemic lupus erythematosus (SLE), even those without clinical manifestations of renal disease. Evaluating renal function in SLE patients is important because early detection and treatment of renal involvement can significantly improve renal outcome.

Clinically, SLE usually presents with fever, weight loss (100%), arthralgias, synovitis, arthritis (95%), pleuritis, pericarditis (80%), malar facial rash, photodermatosis, alopecia (75%), anaemia, leukopaenia, thrombocytopaenia, and thromboses (50%).

About half of cases of SLE demonstrate signs of lupus nephritis at one time or another. Renal-specific signs include proteinuria (100%), nephrotic syndrome (55%), granular casts (30%), red cell casts (10%), microhematuria (80%), macrohematuria (2%), reduced renal function (60%), RPGN (30%), ARF (2%), hypertension (35%), hyperkalemia (15%) and tubular abnormalities (70%).

A diagram of the pathological changes in a glomerulus visible via electron microscopy in SLE nephritis. Black: immune complex; dark purple: basement membrane; pink: endothelium; green: visceral epithelium; light purple: mesangial cells
In histology, stage I (minimal mesangial) disease has a normal appearance under light microscopy, but mesangial deposits are visible under electron microscopy. At this stage urinalysis is typically normal.

stage II disease (mesangial proliferative) is noted by mesangial hypercellularity and matrix expansion. Microscopic haematuria with or without proteinuria may be seen. Hypertension, nephrotic syndrome, and acute renal insufficiency are rare at this stage.

stage III disease (focal lupus nephritis) is indicated by sclerotic lesions involving less than 50% of the glomeruli, which can be segmental or global, and active or chronic, with endocapillary or extracapillary proliferative lesions. Under electron microscopy, subendothelial deposits are noted, and some mesangial changes may be present. Immunofluorescence reveals the so-called "Full House" stain, staining positively for IgG, IgA, IgM, C3, and C1q. Clinically, haematuria and proteinuria is present, with or without nephrotic syndrome, hypertension, and elevated serum creatinine.

Diffuse proliferative lupus nephritis; photo shows the classic "flea-bitten" appearance of the cortical surface in the diffuse proliferative glomerulonephritides
stage IV lupus nephritis (diffuse proliferative) is both the most severe, and the most common subtype. More than 50% of glomeruli are involved. Lesions can be segmental or global, and active or chronic, with endocapillary or extracapillary proliferative lesions. Under electron microscopy, subendothelial deposits are noted, and some mesangial changes may be present. Immunofluorescence reveals the so-called "Full House" stain, staining positively for IgG, IgA, IgM, C3, and C1q. Clinically, haematuria and proteinuria are present, frequently with nephrotic syndrome, hypertension, hypocomplementemia, elevated anti-dsDNA titres and elevated serum creatinine.

Glucocorticoids plus either cyclophosphamide intravenously or mycophenolate mofetil orally should be administered to patients with class III/IV disease; patients with class I/II nephritis do not require immunosuppressive therapy

A wire-loop lesion may be present in stage III and IV. This is a glomerular capillary loop with subendothelial immune complex deposition that is circumferential around the loop. Stage V is denoted by a uniformly thickened, eosinophilic basement membrane. Stage III and IV are differentiated only by the number of glomeruli involved (which is subject to inherent sample bias), but clinically the presentation and prognosis are both expected to be more severe in stage IV versus stage III.

A final stage is usually included by most practitioners, stage VI, or advanced sclerosing lupus nephritis. It is represented by Global sclerosis involving more than 90% of glomeruli, and represents healing of prior inflammatory injury. Active glomerulonephritis is usually not present. This stage is characterised by slowly progressive renal dysfunction, with relatively bland urine sediment. Response to immunotherapy is usually poor.

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Early symptoms of diabetic nephropathy

Diabetic nephropathy

There are no symptoms in the early stages of diabetic nephropathy. If you have kidney damage, you may have small amounts of protein leaking into your urine (microalbuminuria). Normally, protein is not found in urine except during periods of high fever, strenuous exercise, pregnancy, or infection.

Not everyone with diabetes will develop diabetic nephropathy. In people with type 1 diabetes, diabetic nephropathy is more likely to develop 5 to 10 years or more after the onset of diabetes. People with type 2 diabetes may find out that they already have a small amount of protein in the urine (microalbuminuria) at the time diabetes is diagnosed, because they may have had diabetes for several years.

Diabetes affects the arteries of the body and as the kidneys filter blood from many arteries, kidney problems are a particular risk for people with diabetes.

What is Diabetic Nephropathy?
Nephropathy is the deterioration of the kidneys. Diabetic Nephropathy is damage to your kidneys caused by Diabetes. The end-stage of Diabetic Nephropathy is called kidney failure, end-stage kidney disease, or ESRD.

Diabetic Nephropathy develops through five clinical stages, of which the fifth is end-stage kidney failure. Early prevention, detection and treatment are essential for Diabetics to delay or control progression of Diabetic Nephropathy into the next stage.

Micro-Chinese Medicine Osmotherapy treats Diabetic Kidney Disease starting from removing initiating factors of renal fibrosis by Diabetes and creates a favorable environment for repairing injured renal intrinsic cells.

Healthy kidneys are responsible for filtrating bloodstream, carrying away wasteful products and stopping leakage of nutrients out of the body. In Diabetic Nephropathy, glomerular filtering cells are impaired thus causing loss of proteins and retention of wastes (such as urea and blood urea nitrogen). Micro-Chinese Medicine Osmotherapy removes blood stasis, stabilizes blood pressure and removes inflammations, which will stop renal fibrosis and transport sufficient nutrients and blood for fixing damaged glomerular cells. By the treatment kidney function is improved and symptoms can be got rid of effectively.

Diet for Diabetic Nephropathy
Restrict intake of sodium. Heavy sodium consumption will aggravate fluid accumulation in the body. In this way blood volume is increased and blood pressure is even higher. This is very harmful for the kidneys. Limiting sodium helps protect the kidneys and slow down kidney damage.

Balance intake of water. Fluid restriction should be performed carefully if one has severe swelling, obviously reduced urine output, or high blood pressure. In others, if there is no obvious kidney function reduction or fluid retention, there is no need to restrict your intake of water. Talk with your doctor to get individualized instructions.

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Notes diabetic nephropathy

Diabetic nephropathy

Diabetic nephropathy in diabetic nephropathy patients must pay attention to nursing. Diabetic nephropathy is a common complication of diabetes. Diabetic nephropathy patients tend to focus only on medication to control the disease, an important role but ignore the daily nursing care in the treatment of diabetic nephropathy. Nursing of diabetic nephropathy pay attention to what matters.

For the diabetes nephrosis patient's diet, should be divided into two aspects, first, what cannot eat in diabetic nephropathy patients; second, diabetic nephropathy patients eat what is good. Below we have a detailed introduction.

For the diabetes nephrosis patient's diet, should be divided into two aspects, first, what cannot eat in diabetic nephropathy patients; second, diabetic nephropathy patients eat what is good. Below we have a detailed introduction.

Diabetic nephropathy patients eat what is good

Bean Products.Because soy contains large amounts of protein, inorganic salts, vitamins, and unsaturated fatty acids, can reduce blood cholesterol, can reduce blood glycerin three fat effect, contains sitosterol also have lipid-lowering effect.

Crude sugar,Generally contain a variety of trace elements, vitamin B and dietary fiber, such as oat noodles, buckwheat noodles.

Good control of emotions, maintain a good attitude.In patients with diabetic nephropathy in diabetic patients can't control HERSHEY'S, easy to elevated serum cholesterol, resulting in diabetic vascular complications, coronary heart disease.

What cannot eat diabetes nephropathy patients

Can not eat the blood glucose increased food,For example, white sugar, brown sugar, rock sugar, glucose, maltose, etc..

Caution: no hypertension for patients with mild symptoms, not obvious, edema, no impairment of renal function, protein is not much, this kind of patient can do more physical exercise. For edema is obvious, patients or renal insufficiency patients with higher blood pressure, need to rest in bed.

Daily monitoring can not be ignored: restriction of fluid intake, water intake should be controlled in the urine volume before a day plus 500ml is appropriate. Pay more attention to observe the urine volume, color, character change. If there is abnormal when the need for timely report to the physician at least once a week, urine routine and urine specific gravity 1 times.

Pay more attention to the daily symptom changing: To observe the changes of blood pressure, edema, urine volume, urine test results and the patient's renal function; close observation and biochemical indexes: Observation of patients without anemia, electrolyte, acid-base imbalance, urea nitrogen rise higher situation. Such as abnormal timely report to the physician treatment.

Diet control: control of plant protein intake on renal function insufficiency patients, to reduce the burden on the kidneys. In the usual diet to ensure the intake of carbohydrates in the diet, intake, blood glucose control and control carbohydrate, to reduce the decomposition of autologous protein by providing sufficient heat. Limit sodium intake, dietary sodium should be lower than 3G, oliguria, should control the intake of potassium, and ensure comprehensive nutrition.

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