Azotemic or Hydropic Glomerulonephritis

The high concentration of non protein nitrogen (NPN) in the blood of a patient, mainly due to elevated level of urea is termed as azotemia. Elevated level of urea in blood is termed as uremia and it may be due to renal abnormality or due to other health problems like dehydration and excessive burns on the body. The glomerulonephritis (inflammation of glomeruli of kidneys) may be azotemic or hydropic type depending on the nature of glomerular lesions. There may be marked narrowing of the glomerular capillaries leading to azotemia with renal insufficiency and hypertension. On the other hand the status of glomerular capillaries may remain normal but there could be an increase in the permeability of glomerular basement membrane (GBM), the filtration barrier of kidneys. The clinical picture would be hydropic (accumulation of water in the tissues of the body) in character. The hydropic glomerulonephritis is clinically represented with edema associated with hypoproteinemia (low level of protein in blood) and hyperlipemia (high concentration of lipids or cholesterol in blood).

A child or an adult affected with fever or some other acute disease finds the increase in the daily output of urine. There may be tinge of blood in the urine of the patient affected by glomerulonephritis. Sudden appearance of features like puffiness or swelling on face (facial edema), ankles and hands after any acute disease needs expert medical attention and medication. The urine of such patients would show notable excretion of albumin. The patient may be less perspiring with dry skin. The pulse could be full and hard. The loin pain and a feeling of heaviness in the lower abdominal region are the associated symptoms. The polyuria (excessive output of urine) is probably compensatory action of affected kidneys to flush out solid wastes of metabolism form the body. An effective therapy would definitely reverse the associated symptoms and lesions.

What Could Be The Cause Of Swelling On Face

The swelling on face or facial edema should be taken seriously if there is no history of insect bite, wasp sting or honey bee sting and when it is after a throat infection. The swelling on face or facial edema could be due to renal disorder (kidney disease). If on routine examination of urine of the patient, excretion of albumin or protein is detected; there is a need to consult a nephrologist for proper investigations. Blood biochemistry for blood urea, serum creatinine, serum proteins, serum electrophoresis, urine electrophoresis and 24-hour urinary protein should be done. Excretion of protein in 24-hours through urine will help the physician to assess the loss of proteins and possible course of action. Urine electrophoresis would show the type of protein being excreted in the urine. In a patient with nephrotic syndrome, serum electrophoresis would show hypoalbuminemia (low level of albumin in blood), hypogammaglobulinemia (low level of globulins in blood) and raised alpha-2 (a-2) globulin, and urine electrophoresis may show albuminuria (excretion of albumin in urine) or non-selective proteinuria (excretion of almost all the fractions of serum proteins in urine). Total serum protein and its fractions like albumin and globulin would show the altered albumin-globulin ratio. The normal albumin-globulin ratio (^Albumin/_Globulin) is 3:1 and it may be reversed in patients with swelling on face due to kidney disease.

The swelling on face or facial edema is directly associated with albuminuria (excretion of albumin in urine) and salt retention. The loss of blood albumin through urine hinders the return of fluid from the tissues into the blood and may thus lead to development of edema. It is well known that 68 to 70% weight of our body is due to water content in the blood and tissues. Around 12 to 14% of the total water volume of our body is in the blood and the rest is present in the tissues of the body. There is direct correlation between albuminuria (excretion of albumin in urine) and edema. Retention of Chloride is also a common accompaniment of edema. However, there may not be any retention of Chloride in majority of the cases with edema. The edema is perhaps the greatest problem confronting the students of nephrology. Pathological lesions in the kidney need to be evaluated microscopically through renal biopsy examination. Blood urea and serum creatinine may be normal. There may be salt retention without edema and edema without salt retention. The Chloride may collect in watery subcutaneous tissue due to some external factors also without involvement of any renal lesion.

Two forms of swelling on face or facial edema could be recognized and these are called nephritic edema and nephrotic edema. In nephritic edema the protein content of the edema fluid is over 1 gram/dl whereas in nephrotic edema the protein content of the edema fluid is always less than 0.1 gram/dl. Nephritic edema occurs in acute glomerulonephritis. The capillaries in the subcutaneous tissue become more permeable leading to leakage of proteins in the extra cellular fluid. Nephrotic edema occurs in the wet nephritis or second stage of nephritis, in nephrosis and also in renal amyloidosis. The edema is caused due to the great fall in the osmotic pressure of the blood due to constant loss of protein in urine; so, the fluid from the blood vessels escapes into the tissues in an effort to correct the viscosity of blood plasma.