What is Glomerulonephritis?
Glomerulonephritis (GN) is a condition characterised by inflammation of the glomeruli, which are tiny structures in your kidneys composed of small blood vessels. These structures are crucial in filtering your blood and removing excess fluids. When inflamed, they can cause your kidneys to stop working properly, leading to serious health issues, including kidney failure [1].
What causes Glomerulonephritis?
The causes of glomerulonephritis are diverse and can be both acute and chronic.
Acute Glomerulonephritis:
Certain illnesses are known to trigger acute GN, including strep throat, systemic lupus erythematosus (also called lupus), Goodpasture syndrome (a rare autoimmune disease in which antibodies attack your kidneys and lungs), and amyloidosis (which occurs when abnormal proteins that can cause harm build up in your organs and tissues) [2].
Chronic Glomerulonephritis:
Chronic GN can develop over several years with no or very few symptoms. This can cause irreversible damage to your kidneys and ultimately lead to complete kidney failure. Chronic GN doesn't always have a clear cause.
A genetic disease can sometimes cause chronic GN. Other possible causes include certain immune diseases, a history of cancer, exposure to some hydrocarbon solvents, and having the acute form of GN may make you more likely to develop chronic GN later on [2].
What is Encephalopathy?
Encephalopathy is a general term that describes a disease affecting the function or structure of your brain. It can manifest as a broad spectrum of neurological or psychiatric abnormalities, ranging from subclinical alterations to coma [3, 4]. The condition can be temporary or permanent; some types are present from birth and never change, while others are acquired after birth and may progressively worsen [4].
The underlying causes of Encephalopathy are diverse and can include primary neurologic and systemic conditions [5]. For instance, it can be caused by global brain insults or focal lesions, and the onset and evolution can vary, including sudden, acute, subacute, and chronic [5].
Infections can cause Encephalopathy either by directly invading the brain or its surrounding areas or through other mechanisms triggered by the infection, like acute disseminated encephalomyelitis[6].
Metabolic imbalances, such as those seen in hepatic Encephalopathy, can also cause Encephalopathy. In hepatic Encephalopathy, liver failure or a condition called portal-systemic shunt causes toxins to build up in the body that the liver typically clears out. These toxins can eventually affect the brain [3].
In newborns, Encephalopathy can be caused due to hypoxic-ischemic damage, mostly occurring in the womb for full-term babies. However, for premature infants, there exist various factors can harm brain tissue after birth. [7].
How does Glomerulonephritis cause encephalopathy?
Glomerulonephritis can lead to Encephalopathy through several mechanisms.
Hypersensitive Encephalopathy: One of the primary ways that GN causes Encephalopathy is through the development of hypertensive Encephalopathy. Glomerulonephritis can cause episodic hypertension, which can lead to hypertensive Encephalopathy characterised by symptoms such as headache, vomiting, and, in some cases, cortical blindness [8, 9].
Uremic encephalopathy: Another mechanism is through the development of uremic encephalopathy. Glomerulonephritis usually causes acute or chronic renal failure, which can result in the accumulation of uremic toxins in the body. These toxins cause widespread dysfunction of the central nervous system, leading to uremic Encephalopathy, a condition characterised by a range of neurological symptoms.
It's important to note that the development of Encephalopathy in patients with Glomerulonephritis is a complex process and can be influenced by various factors, including the patient's overall health, the severity of the kidney disease, and other medical conditions.
Treating Encephalopathy caused by Glomerulonephritis
Encephalopathy due to Glomerulonephritis requires a multifaceted treatment approach. The primary goal is to manage the underlying Glomerulonephritis and control symptoms of Encephalopathy.
One of the critical steps in treating Encephalopathy due to Glomerulonephritis is managing hypertension, which is often associated with this condition. Antihypertensive therapy is effective in cases where Encephalopathy is a complication of hypertensive Encephalopathy associated with acute Glomerulonephritis [8].
In some cases, immunosuppressive therapy might be necessary. For instance, a patient with anti-glomerular basement membrane disease, a type of rapidly progressive Glomerulonephritis, showed improvement in symptoms of Encephalopathy put through corticosteroid pulse therapy, oral cyclophosphamide and prednisolone, and plasma exchange [8].
In cases where Encephalopathy is associated with uremia, a condition that can develop in patients with acute or chronic renal failure, hemodialysis is required to improve symptoms [10, 11].
In some cases, Encephalopathy can be reversed with the proper treatment. For instance, a patient with posterior reversible encephalopathy syndrome (PRES), which mainly occurs in people with Glomerulonephritis, wholly recovered after appropriate management of their blood pressure. [12].
However, it's important to note that the treatment approach can vary greatly depending on the individual patient's condition and the specific causes of the Encephalopathy. Therefore, a healthcare provider should always be consulted for personalised treatment advice.