Transcription:

Melanie Cole (Host):  Welcome to The GW HealthCast. I’m Melanie Cole and today’s topic is the Management of Glomerulonephritis and my guest is Dr. Scott Cohen. He’s a physician in the Division of Kidney Disease and Hypertension at the GW Medical Faculty Associates and an Associate Professor of Medicine at the George Washington University School of Medicine and Health Sciences and is affiliated with The George Washington University Hospital. Dr. Cohen, before we begin, I’d like you to give us a little bit of a physiology lesson about the kidneys. What are their functions? What do they do?

Scott Cohen, MD, MPH, FASN (Guest):  So, the kidneys filter waste products. They are the main way to eliminate wastes in the blood and so the kidney will filter the blood to remove the toxins.

Host:  Tell us about the current state of kidney disease today. What’s the prevalence of people that have kidney disease and why do so many people not realize that they have it until it shows symptoms?

Dr. Cohen:  Yeah, so there’s over 20 million Americans with some form of chronic kidney disease. It’s quite prevalent and unfortunately, it can a silent condition. Without regular blood testing or testing of the urine, many patients don’t know that they even have kidney disease.

Host:  Then tell us what is glomerulonephritis?

Dr. Cohen:  So, that’s an inflammation of the filters of the kidney so each kidney is made up of a million filtering units called nephrons and the glomeruli sit at the beginning of those filtering units, at the beginning of those nephrons and they get inflamed by different disease states. Then that causes the nephritis.

Host:  Is this a condition that’s most often acute or is it chronic?

Dr. Cohen:  It can be acute, and it can evolve into chronic forms of glomerulonephritis, ultimately leading to progressive chronic kidney disease. So, close monitoring is definitely indicated.

Host:  And as you tell us some of the complications that could be associated with it; what is it that somebody would notice, common symptoms or signs that they would even have anything going on with their kidneys?

Dr. Cohen:  Yeah, so, symptoms could range from swelling that could be in the ankles, sometimes it gets worse in the ankles at the end of the day because of gravity. Sometimes patients have swelling around their eyes when they first get up in the morning, what we call periorbital swelling. It could also manifest with foamy urine, so bubbles in the urine which can be a manifestation of protein in the urine. Otherwise, it could be very nonspecific. Some patients just feel flu-like symptoms, fatigue. They could have shortness of breath; nausea and you wouldn’t necessarily think it was the kidney until you actually did the bloodwork or urine testing. That’s why this is a silent condition many times.

Host:  If someone isn’t recognizing some of these symptoms; if it’s an acute case, what are some of the complications? What could happen to someone if they don’t get treated?

Dr. Cohen:  Yeah, so, potentially if patients go untreated, they can ultimately lead to loss of kidney function and kidney failure and require need for dialysis or kidney transplantation if they’re eligible.

Host:  How do you diagnose it and does someone notice some of these symptoms? You mentioned the puffiness around the eyes or swelling in the legs and do they go to the emergency room or would they go to a doctor first?

Dr. Cohen:  Yeah, so, you wouldn’t necessarily need to go to the emergency room first unless you were having severe symptoms. But definitely if you are having swelling that’s unexplained by some other cause; getting checked out by your doctor first and getting blood tests and urine testing done would be the best screening tests for kidney disease.

Host:  Then tell us about treatments Dr. Cohen, first line treatment and while you are discussing that, tell us where dietary modifications fit into this picture.

Dr. Cohen:  Sure. So, treatment depends on the cause of the glomerulonephritis and many times that would require a kidney biopsy where we take a small sample of kidney tissue and send it to the pathologist to be analyzed under the microscope to determine what is causing the inflammation in the kidney filters or the glomerulonephritis and then depending on the cause; some patients may require immune suppressing medication to control the inflammation in the kidney. That immune medication may involve things like corticosteroids, prednisone. So, certain medications that are used to treat other autoimmune diseases also may be used to treat glomerulonephritis. So, that is the treatment in terms of medications.

There is a very essential role for lifestyle modification, dietary therapy as well for all patients with kidney disease. We encourage patients to follow a low sodium diet and encourage patients to follow more of a plant based diet, a vegetarian style diet as well.

Host:  As people in this country Dr. Cohen have so many comorbid conditions, such as diabetes, and high blood pressure; our kidneys kind of take some of the brunt of these diseases. Speak about the comorbid conditions and how that might put us at risk for a kidney issue.

Dr. Cohen:  Yeah, so definitely the number one cause for chronic kidney disease in this country is diabetes followed by hypertension and the third most common cause of chronic kidney disease is glomerular diseases and things like glomerulonephritis. So, recognizing these disease states and kind of screen for them and then how to treat is an essential role for the nephrologist.

Host:  When people hear kidney issues Dr. Cohen, right away they think of dialysis. So, in an acute situation; do the treatments that you’ve mentioned take care of the problem and then it goes away? Or does it necessarily follow that it becomes chronic and has to be watched for life?

Dr. Cohen:  Yeah, so, when patients present to us with glomerulonephritis, glomerular diseases, that doesn’t necessarily mean dialysis. In many circumstances, we can control the glomerular disease and even improve the kidney function with therapy to prevent the dialysis. Different types of kidney disease have different prognosis obviously. It depends on the type of kidney disease. If we see a lot of inflammation in the kidney, we can many times reverse that and reverse the acute glomerulonephritis with treatment such as corticosteroids or other immune suppressing medications. So, it doesn’t necessarily mean dialysis particularly for the particular disease we are talking about this afternoon.

Host:  Can even kids come down with glomerulonephritis?

Dr. Cohen:  Absolutely. This is a condition called nephrotic syndrome that can present in kids with swelling around the eyes and severe swelling at the end of the day and the foam or bubbles in the urine and that’s something that can be seen in children as well. Yeah.

Host:  How would a parent know. I mean anything that happens with our kids is certainly scary, but I mean a kid isn’t going to necessarily say I’ve got foamy pee or any of those kinds of things. What would signal a parent to say wow, you know, this is not normal?

Dr. Cohen:  Yeah, so, if the parent notices swelling around the eyes in the morning or in the lower extremities at the end of the day or foam in the urine or a change in color of the urine, if the urine turns more of a brownish color, that could also indicate some blood coming from the kidney tissue itself coming from the glomerulus could indicate also glomerular inflammation and glomerulonephritis. So, these are all symptoms that may indicate that there’s an issue that needs to be checked out by the primary care doctor first, followed by the nephrologist if necessary.

Host:  If kids don’t have diabetes or high blood pressure, what would put them at risk for this as an acute condition? Really do we know what causes it?

Dr. Cohen:  So, sometimes it’s a disorder of the immune system that triggers the glomerulonephritis. Sometimes it’s an infection that triggers the glomerulonephritis. Sometimes we don’t know the exact cause. On occasion, a medication causes the symptoms and can trigger the inflammation in the kidney.

Host:  Wow, that’s so interesting. Doctor, as you will wrap it up for us, please tell us what you’d like us to know about glomerulonephritis and kidney disease in general and as your best advice as a nephrologist, how you would like people to think about their kidneys and protecting them and those lifestyle modifications again.

Dr. Cohen:  Yeah, so, glomerulonephritis should be – it’s important to recognize, is the third most common cause of chronic kidney disease, right behind diabetes and hypertension and yet, because it’s more rare, it’s not as recognized and requires a kidney biopsy in most circumstances to make that diagnosis of glomerulonephritis. It really does require close consultation with a nephrologist to develop the treatment plan which in many circumstances involves using medications to suppress the immune system and control the inflammation in the kidney tissue. Recognizing the symptoms of glomerulonephritis is important as we talked about like the swelling and the foam in the urine, change in the color of the urine to a brownish color. These are all potential signs of the inflammation in the kidney.

The diet is very, very important as we talked about the low sodium diet and doing more of a plant based style diet are all critical factors as well.

Host:  Well they certainly are. Thank you so much Dr. Cohen for joining us today and giving us such great education and information about something that people may not know much about and the great information about kidney disease in general. You're listening to the GW Healthcast. Please visit GWDocs.com to get connected with Dr.Cohen or another provider, or call 1-888-4GW-DOCS to schedule an in-person or virtual appointment. I’m Melanie Cole. Thanks so much for tuning in.