Autoimmune kidney diseases are a group of conditions where the body’s immune system mistakenly attacks and damages the kidneys. This leads to inflammation and, eventually, kidney failure. Glomerulonephrites (pleural) are autoimmune kidney diseases.
By Majd Isreb, MD, FACP, FASN, IFMCP
Glomerulonephrites (GN) are the world’s third leading cause of kidney disease and failure. It is a group of autoimmune kidney diseases named according to the site they involve in the kidneys and how they appear under the microscope.
Types of glomerulonephrites
GNs are generally classified into “primary” or “secondary.” In primary GN, the kidney is the only apparent site of autoimmune injury. While in secondary GN, kidney injury is one of the manifestations of a systemic autoimmune or non-autoimmune disease. Most of these GNs can be acute or chronic.
The most common primary glomerulonephrites include:
- IgA nephropathy: Also known as Berger’s disease, this is the most common type of autoimmune kidney disease. It occurs when immunoglobulin A (IgA) deposits in the kidneys and triggers an immune response.
- Focal Segmental glomerulosclerosis (FSGS): This is characterized by scarring of the tiny filtering units in the kidney (glomeruli) and leads to a progressive decline in kidney function.
- Membranous nephropathy occurs when the immune system attacks the thin layer of tissue (basement membrane) that separates the glomerular filtration barrier.
- Mesangioproliferative GN (MPGN): This is an uncommon kidney disorder characterized by the proliferation (growth) of specific glomerular cells and structural changes in glomerular capillary walls and basement membrane.
- Minimal change disease: In this disorder, the kidney biopsy shows normal findings on a light microscope, but detailed examination shows minor changes in specific glomerular filtering cells under an electron microscope. Some consider this disease on the same spectrum as FSGS.
- Rapidly progressive GN (RPGN): This is an aggressive form of GN seen in vasculitis and can lead to rapid loss of kidney function within days to weeks.
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The most common secondary glomerulonephrites include:
- Postinfectious glomerulonephritis
- Systemic vasculitis
- Lupus nephritis
- Monoclonal gammopathy of renal significance
- Thrombotic microangiopathy
- HIV-related nephropathy
Many primary glomerulonephrites can be a pathological presentation of a systemic process.
Symptoms of Autoimmune Kidney Diseases
Injury to the glomeruli leads to various symptoms and signs. For example, protein can appear in the urine (proteinuria) due to protein leak through the capillary walls of the glomeruli. Blood can also appear in the urine (hematuria) due to ruptured capillaries.
The injury can also decrease the clearance of waste products by the kidneys leading to the accumulation of various toxins. It can lead to a decrease in urine output. Salt and water retention can occur, leading to swelling (edema). Blood pressure can also rise due to disturbed renal balance of blood pressure.
Therefore, it is essential to think of glomerulonephrites when there:
- Dark urine (tea-colored urine) or blood in the urine.
- Excessively foamy or bubbly urine (a sign of excessive protein in the urine)
- Swelling in the legs (especially in the evening) and or the face (especially in the morning)
- Frequent nighttime urination
- Elevated blood pressure
- Symptoms of decreased clearance of waste products such as nausea and vomiting, poor appetite, fatigue, itching, insomnia, and muscle cramps.
Several serological tests can point to one type of GN or another. However, the diagnosis is usually confirmed by a kidney biopsy.
What causes autoimmune kidney diseases?
The triggers for autoimmune kidney diseases are not fully understood, but some factors that are believed to play a role include:
- Genetics: A family history of autoimmune diseases increases the likelihood of developing an autoimmune kidney disease. Certain genetic variants have been associated with certain types of GN.
- Environmental triggers: Certain infections, toxins, or medications can trigger an autoimmune response and contribute to the development of autoimmune kidney diseases.
- Hormonal imbalances: Hormonal changes can lead to a flare-up of autoimmune kidney diseases in some individuals.
- Certain foods: some food such as gluten, soy, or dairy has been associated with GN in certain people.
- Dysbiosis: An increasing body of evidence links dysbiosis with various autoimmune kidney diseases.
In addition, some mediators may worsen autoimmune kidney diseases, such as diet, nutritional deficiencies, psychological stress, and lack of sleep.
The bottom line
Diagnosis of autoimmune kidney diseases is typically based on a combination of medical history, physical exam, and laboratory tests. This may include a urine test to check for protein, blood tests to assess kidney function, and a biopsy to confirm the diagnosis.
Treatment for autoimmune kidney diseases depends on the type and severity of the condition. The integrative approach depends on identifying the predisposing factors and triggers to GN. It manages various mediators and the inflammation associated with them. This approach parallels the conventional method often needed to extinguish some of these aggressive GN.
