Bright's Disease: Symptoms, Causes, Diagnosis, And Treatment

Bright’s disease is a historic name for a group of diseases that causes inflammation of the glomeruli. To understand what glomeruli are, you should first know that the kidney has around one million “nephrons,” which are structural organ units. In these nephrons are tubes (so tiny that they are called tubules). 

The tubules are responsible for transporting substances the body needs, such as nutrients, once the blood has been filtered by the glomeruli. Glomeruli are groups of capillaries or blood vessels found at the end of a tubule.

The role of glomeruli is to remove excess fluids, salts, and toxins from the blood. When the glomeruli are damaged, your kidney may stop functioning well. Serious damage to the glomeruli may result in kidney failure.

Bright's disease is also known as glomerulonephritis. Nephritis is a simple way of referring to the disease. Your physician may abbreviate the disease as GN (glomerulonephritis).

Acute and Chronic

Bright's disease has two types: acute glomerulonephritis and chronic glomerulonephritis. Acute glomerulonephritis starts suddenly (for example, deteriorating kidney function within a few weeks). Chronic glomerulonephritis can either start slowly or be the consequence of acute glomerulonephritis.

How common is glomerulonephritis?

Glomerulonephritis is one of the main causes of kidney failure in the U.S. It causes between 10% and 15%¹ of kidney failure cases. The disease is so common that it accounts for up to 10% of patients in dialysis.

Symptoms of glomerulonephritis

The type of Bright's disease determines the nature and severity of the symptoms that you may experience. The symptoms that you may observe are;

I. Acute Bright's disease

In the early stages, your symptoms may include:

• Reduced urination frequency

• New high blood pressure or worsening of previous high blood pressure

• Coughing caused by extra fluid in the lungs

• Blood in urine

• Facial swelling

• General lethargy and weakness

II. Chronic Bright's disease

You may not observe any symptoms in the case of chronic Bright's disease. You may also witness some signs listed below that develop slowly:

• Excess protein or blood in urine- microscopic tests will be required to identify the presence of proteins such as creatinine in urine. The urine may turn color due to the presence of blood.

• Frequent urination, especially at night

• Face swelling; swelling may also be observed on the ankles

• High blood pressure

• Bubbly or foamy urine

III. Kidney failure

In severe cases, Bright's disease could develop into kidney failure. You may observe the following symptoms:

• Poor sleep

• Fatigue

• Skin dryness, which may be accompanied by itchiness

• Loss of appetite

• Muscle cramps and weakness

• Difficulty breathing on exertion or when lying flat 

• Decrease in urine output

• Nausea and vomiting

• Tremors

Causes of glomerulonephritis (GN)

To understand the causes of Bright's disease, you should consider the two ways it manifests, acute or chronic.

The symptoms for each form of the disease are discussed below:

1. Acute glomerulonephritis (Bright's disease)

Acute Bright’s disease may occur as an overreaction by the body to a particular infection or an autoimmune reaction. The acute form of the disease may resolve on its own but often requires some form of treatment and close monitoring. 

Some can be very aggressive early on. It is therefore important to consult a doctor to prevent possible irreversible damage to the kidneys.

Illnesses that are known to cause acute glomerulonephritis include:

• Strep throat

• Goodpasture syndrome (a rare disease in which the immune system attacks lungs and kidneys)

• Granulomatosis with polyangiitis (formerly Wegner’s disease involving inflammation of blood vessels)

• Systemic lupus erythematosus (lupus)

• Polyarteritis nodosa (arteries attacked by cells)

2. Chronic glomerulonephritis (Bright's disease)

The chronic form of Bright's disease develops over a long period. You may not have any disease symptoms during the development period or only exhibit a few mild ones. This form of the disease could cause serious kidney damage if it is not detected and treated promptly. 

Therefore, you should consult your doctor if you detect any symptoms. You should also do a comprehensive health checkup that includes the kidneys regularly.

There are several causes of this type of Bright's disease, such as genetic diseases. Some young males with poor vision and hearing may also experience hereditary nephritis, such as in the case of Alport syndrome.

Chronic Bright's disease may also be caused by:

• Some forms of cancer

• Prolonged exposure to some hydrocarbons

• Autoimmune diseases such as systemic lupus and erythematosus

• IgA Nephropathy - an autoimmune disease that damages the kidney 

Diagnosis

A healthcare professional may carry out several tests to determine the presence of Bright’s disease and rule out other diseases.

Urine tests

Bright's disease is often discovered incidentally as you take tests for other (usually chronic) diseases. Based on a doctor's recommendation, you may have to take urine tests. The first step is to check for protein and blood in the urine.

Several urine tests will enable your doctor to assess the health of your kidneys. They include:

• Creatinine clearance tests: measure the levels of creatinine present in your blood and urine. Abnormal creatinine levels in the urine suggest that the kidneys have an issue.

• Urine concentration: the levels of substances such as chlorine in the urine indicate the kidney's effectiveness in filtering the blood. 

• Urine red blood cells: many red blood cells in the urine indicate that you may have nephritic syndrome. 

• Urine-specific gravity: refers to the proportion of solids to liquids in a given solution relative to the density of water. Higher than normal urine specific gravity may indicate that you have nephritis or Bright's disease.

• Urine osmolality: refers to the concentration of solid substances relative to the volume of water present. High osmolality may indicate that the functioning of the kidney has reduced, as may be the case with Bright's disease.

Kidney biopsy

A kidney biopsy entails looking at a piece of the kidney with a powerful microscope. The sample may be taken out in one of the following ways;

• Percutaneous (through the skin) - A needle is used to get a sample by inserting it through the skin that lies on the kidney. This is the most common type of biopsy.

• Open - a sample is taken directly from the kidney during surgery.

Imaging tests

Imaging tests may be requested to rule out any other causes of blood in the urine and potential kidney failure:

• Kidney ultrasound

• Intravenous pyelogram

• CT scan

Blood tests

Your doctor may also prescribe a blood test. The test will involve taking your blood to a lab for testing as per your doctor's directions.

There are numerous possible outcomes when one undertakes blood tests. Some outcomes include:

• Abnormal blood urea nitrogen

• High creatinine levels

• Anemia

Other tests include antibody tests for autoimmune disease and testing for strep bacteria.

Lifestyle management for glomerulonephritis

You can make the following adjustments to better cope with the condition:

Reduce the amount of salt intake

You should reduce your salt intake if you have glomerulonephritis. Consuming large amounts of salt could cause high blood pressure, further straining the kidneys.

Quit smoking

It would be best if you did not smoke when you have glomerulonephritis. Smoking negatively affects the medicine used to treat high blood pressure.

Maintain a healthy weight

High body weight causes the kidneys to strain, thereby increasing the risk of Bright's disease.

Consume less protein and potassium

With reduced kidney function, you should reduce protein intake. High protein levels in the blood may cause discomfort such as nausea, weakness, and loss of appetite. This should be guided by a dietitian as you do need some protein to adequately maintain muscle mass, etc.

Treatment of glomerulonephritis

Your doctor will consider the type of Bright's disease you are experiencing and its cause to recommend suitable treatment. If the cause of your Bright's disease is an infection, for example, then the doctor may prescribe antibiotics to treat it.

Dialysis

In case Bright's disease advances, kidney failure could occur. Your doctor could prescribe dialysis, where machines will filter your blood. Eventually, your doctor may recommend a kidney transplant.

Corticosteroids

Your doctor may prescribe corticosteroids when certain autoimmune responses limit the normal functioning of the kidney. This will suppress the immune system. Other types of immunosuppressants may be required as well.

Inflammation triggered by the immune system may also be treated with plasmapheresis. The treatment involves replacing your plasma (the liquid part of the blood) with donated plasma or intravenous fluids. The donated plasma will not contain harmful antibodies, thereby stopping the reaction.

General medication

Your doctor is likely to recommend the use of angiotensin-converting enzyme inhibitors (ACE inhibitors) such as:

• Lisinopril (Zestril)

• Captopril

• Perindopril (Aceon)

Your doctor may prescribe angiotensin receptor blockers, or ARBs, such as;

• Irbesartan (Avapro)

• Iosartan (Cozaar)

• Valsartan (Diovan)

Both of these types of medications help to reduce blood pressure and slow down kidney disease. It will help reduce protein excretion as well. 

Other treatments that your doctor may recommend could include:

• Reducing your fluids intake and using calcium supplements

• Taking diuretics to reduce swelling in areas such as the face and ankles

• Assistance from a dietician to enable you to select suitable foods

Can glomerulonephritis be prevented?

There are no proven ways to prevent Bright's disease. The following practices, however, may be helpful;

• Look out for symptoms such as blood in the urine or “Coke-colored” urine, which is a sign of blood. 

• Embrace practices that will enable you to reduce the risk of high blood pressure, such as meditating, exercising regularly, and eating a low-salt diet.

• Reduce the number of infections: practice safe sex and observe hygiene.

• Eat healthy food: unprocessed foods may help reduce the risk of getting Bright's disease.

When to visit a doctor?

It would be best to visit your doctor any time you think you have an infection, as infections can cause Bright's disease. You should also consult a doctor when you exhibit uncomfortable symptoms mentioned above or when you observe foam or an unusual color in your urine.

The lowdown

When detected early, acute Bright's disease can be treated and is possibly reversible. You can also recover from chronic Bright's disease when diagnosed early. Therefore, you should look out for the symptoms discussed above and consult your doctor each time you have an infection.

Regardless of the stage of the condition, there are appropriate medical interventions. For instance, in the case of kidney failure, your doctor may recommend dialysis. Your doctor may also recommend a transplant based on case-specific factors.

Follow your doctor's advice concerning diagnosis, prevention, and treatment.