What is Bright’s disease

Bright’s disease is a very old term used to describe patients who have glomerulonephritis. Glomerulonephritis is inflammation of the tiny filters in your kidneys (glomeruli). Glomeruli remove excess fluid, electrolytes and waste from your bloodstream and pass them into your urine. Bright’s disease (glomerulonephritis) may be acute or chronic (coming on gradually), and may occur on its own (primary) or be caused by another condition (secondary). Bright’s disease (glomerulonephritis) can occur on its own or be a part of another disease, such as lupus or diabetes.

Severe or prolonged inflammation associated with glomerulonephritis can damage your kidneys.

Bright’s disease signs and symptoms may depend on the type and cause of the glomerulonephritis and may include blood in the urine; foamy urine; swelling of the face, eyes, or other body parts; abdominal pain; high blood pressure; fatigue; and/or other symptoms. If the glomerulonephritis is severe or prolonged, the kidneys can become damaged. It may be caused by a variety of infections and diseases, and sometimes the cause is unknown.

Treatment depends on the cause, type and severity of your Bright’s disease (glomerulonephritis).

Is Bright’s disease hereditary?

Most of the time, Bright’s disease (glomerulonephritis) is not inherited. It may be caused by a variety of conditions ranging from infections that affect the kidneys to diseases that affect the whole body, including the kidneys. Currently available data suggest that most cases are due to an immunologic response to a variety of things. Sometimes the cause is unknown.

Infrequently, chronic Bright’s disease (glomerulonephritis) runs in families and may be inherited. One known inherited form, Alport syndrome, may also involve hearing or vision impairment. Alport syndrome may be inherited in several ways depending on the disease-causing gene. Some complement deficiencies (which affect the body’s immune response), which may be inherited, can predispose affected individuals to membranoproliferative glomerulonephritis. Another example of an inherited cause of Bright’s disease (glomerulonephritis) is dominant intermediate Charcot-Marie-Tooth disease E (CMTDIE), which may also be referred to as Charcot-Marie-Tooth neuropathy with focal segmental glomerulonephritis ¹.

There have been several reports of seemingly familial cases of Bright’s disease (glomerulonephritis) in the medical journals. Online Mendelian Inheritance in Man (OMIM) is an online catalog of human genes and genetic disorders; each entry summarizes the information that has been published in medical journals. Although this database is designed for professionals, OMIM may be helpful to anyone looking for comprehensive information. Because the information in OMIM is complex, you may benefit from discussing it with a medical professional. To view the search results containing genetics resources for Bright’s disease (glomerulonephritis) in the OMIM catalog, click here (https://www.ncbi.nlm.nih.gov/omim?Db=omim&Cmd=DetailsSearch&Term=glomerulonephritis%5BAll+Fields%5D).

Bright’s disease causes

A variety of conditions can cause Bright’s disease (glomerulonephritis), ranging from infections that affect the kidneys to diseases that affect the whole body, including the kidneys. Sometimes the cause is unknown.

Acute Bright’s disease (glomerulonephritis) (a sudden attack of inflammation) may be caused by infections such as strep throat, impetigo, or bacterial endocarditis. Other infections that may cause Bright’s disease (glomerulonephritis) include HIV, hepatitis B, and hepatitis C. Bright’s disease (glomerulonephritis) may also be caused by immune diseases such as lupus, Goodpasture’s syndrome, and IgA nephropathy. Types of vasculitis that may cause the condition include Wegener’s granulomatosis and polyarteritis nodosa. Chronic Bright’s disease (glomerulonephritis) sometimes develops after an episode acute Bright’s disease (glomerulonephritis).

In some cases, Bright’s disease (glomerulonephritis) is caused by an inherited condition. One of these is Alport syndrome (also known as hereditary nephritis). Individuals with Alport syndrome may also have hearing and/or vision loss. Alport syndrome can have different inheritance patterns depending on the disease-causing gene involved.

Infections

• Post-streptococcal glomerulonephritis. Glomerulonephritis may develop a week or two after recovery from a strep throat infection or, rarely, a skin infection (impetigo). To fight the infection, your body produces extra antibodies that can eventually settle in the glomeruli, causing inflammation. Children are more likely to develop post-streptococcal glomerulonephritis than are adults, and they’re also more likely to recover quickly.
• Bacterial endocarditis. Bacteria occasionally can spread through your bloodstream and lodge in your heart, causing an infection of one or more of your heart valves. You’re at greater risk of this condition if you have a heart defect, such as a damaged or artificial heart valve. Bacterial endocarditis is associated with glomerular disease, but the connection between the two is unclear.
• Viral infections. Viral infections, such as the human immunodeficiency virus (HIV), hepatitis B and hepatitis C, can trigger Bright’s disease (glomerulonephritis).

Immune diseases

• Lupus. A chronic inflammatory disease, lupus can affect many parts of your body, including your skin, joints, kidneys, blood cells, heart and lungs.
• Goodpasture’s syndrome. A rare immunological lung disorder that can mimic pneumonia, Goodpasture’s syndrome causes bleeding in your lungs as well as Bright’s disease (glomerulonephritis).
• IgA nephropathy. Characterized by recurrent episodes of blood in the urine, this primary glomerular disease results from deposits of immunoglobulin A (IgA) in the glomeruli. IgA nephropathy can progress for years with no noticeable symptoms.

Vasculitis

• Polyarteritis. This form of vasculitis affects small and medium blood vessels in many parts of your body, such as your heart, kidneys and intestines.
• Granulomatosis with polyangiitis. This form of vasculitis, formerly known as Wegener’s granulomatosis, affects small and medium blood vessels in your lungs, upper airways and kidneys.

Conditions likely to cause scarring of the glomeruli

• High blood pressure. This can damage your kidneys and impair their ability to function normally. Glomerulonephritis can also lead to high blood pressure because it reduces kidney function and can influence how your kidneys handle sodium.
• Diabetic kidney disease (diabetic nephropathy). This can affect anyone with diabetes, usually taking years to develop. Good control of blood sugar levels and blood pressure might prevent or slow kidney damage.
• Focal segmental glomerulosclerosis. Characterized by scattered scarring of some of the glomeruli, this condition can result from another disease or occur for no known reason.

Infrequently, chronic Bright’s disease (glomerulonephritis) runs in families. One inherited form, Alport syndrome, also might impair hearing or vision.

In addition to the causes listed above, Bright’s disease (glomerulonephritis) is associated with certain cancers, such as multiple myeloma, lung cancer and chronic lymphocytic leukemia.

Bright’s disease prevention

There may be no way to prevent most forms of glomerulonephritis. However, here are some steps that might be beneficial:

• Seek prompt treatment of a strep infection with a sore throat or impetigo.
• To prevent infections that can lead to some forms of glomerulonephritis, such as HIV and hepatitis, follow safe-sex guidelines and avoid intravenous drug use.
• Control high blood pressure, which lessens the likelihood of damage to your kidneys from hypertension.
• Control your blood sugar to help prevent diabetic nephropathy.

Bright’s disease symptoms

Bright’s disease (glomerulonephritis) signs and symptoms depend on whether you have the acute or chronic form and the cause. Your first indication that something is wrong might come from symptoms or from the results of a routine urinalysis.

Glomerulonephritis signs and symptoms include:

• Pink or cola-colored urine from red blood cells in your urine (hematuria)
• Foamy urine due to excess protein (proteinuria)
• High blood pressure (hypertension)
• Fluid retention (edema) with swelling evident in your face, hands, feet and abdomen

Bright’s disease complications

Glomerulonephritis can damage your kidneys so that they lose their filtering ability. As a result, dangerous levels of fluid, electrolytes and waste build up in your body.

Possible complications of glomerulonephritis include:

• Acute kidney failure. Loss of function in the filtering part of the nephron can result in rapid accumulation of waste products. You might need emergency dialysis — an artificial means of removing extra fluids and waste from your blood — typically by an artificial kidney machine.
• Chronic kidney disease. Your kidneys gradually lose their filtering ability. Kidney function that deteriorates to less than 10 percent of normal capacity results in end-stage kidney disease, which requires dialysis or a kidney transplant to sustain life.
• High blood pressure. Damage to your kidneys and the resulting buildup of wastes in the bloodstream can raise your blood pressure.
• Nephrotic syndrome. With this syndrome, too much protein in your urine results in too little protein in your blood. Nephrotic syndrome can be associated with high blood cholesterol and swelling (edema) of the eyelids, feet and abdomen.

Bright’s disease diagnosis

Bright’s disease (glomerulonephritis) often comes to light when a routine urinalysis is abnormal. Tests to assess your kidney function and make a diagnosis of glomerulonephritis include:

• Urine test. A urinalysis might show red blood cells and red cell casts in your urine, an indicator of possible damage to the glomeruli. Urinalysis results might also show white blood cells, a common indicator of infection or inflammation, and increased protein, which can indicate nephron damage. Other indicators, such as increased blood levels of creatinine or urea, are red flags.
• Blood tests. These can provide information about kidney damage and impairment of the glomeruli by measuring levels of waste products, such as creatinine and blood urea nitrogen.
• Imaging tests. If your doctor detects evidence of damage, he or she may recommend diagnostic studies that allow visualization of your kidneys, such as a kidney X-ray, an ultrasound examination or a CT scan.
• Kidney biopsy. This procedure involves using a special needle to extract small pieces of kidney tissue for microscopic examination to help determine the cause of the inflammation. A kidney biopsy is almost always necessary to confirm a diagnosis of glomerulonephritis.

Bright’s disease treatment

Bright’s disease treatment and your outcome depend on:

• Whether you have an acute or chronic form of the disease
• The underlying cause
• The type and severity of your signs and symptoms

Some cases of acute glomerulonephritis, especially those that follow a strep infection, might improve on their own and require no treatment. If there’s an underlying cause, such as high blood pressure, an infection or an autoimmune disease, treatment will be directed to the underlying cause.

In general, the goal of treatment is to protect your kidneys from further damage.

Therapies for associated kidney failure

For acute glomerulonephritis and acute kidney failure, dialysis can help remove excess fluid and control high blood pressure. The only long-term therapies for end-stage kidney disease are kidney dialysis and kidney transplant. When a transplant isn’t possible, often because of poor general health, dialysis is the only option.

Lifestyle and home remedies

If you have kidney disease, your doctor might recommend certain lifestyle changes:

• Restrict your salt intake to prevent or minimize fluid retention, swelling and hypertension
• Consume less protein and potassium to slow the buildup of wastes in your blood
• Maintain a healthy weight
• Control your blood sugar level if you have diabetes
• Quit smoking

Coping and support

Living with a chronic illness can tax your emotional resources. If you have chronic glomerulonephritis or chronic kidney failure, you might benefit from joining a support group. A support group can provide both sympathetic listening and useful information.

To find a support group, ask your doctor for a recommendation or contact the National Kidney Foundation (https://www.kidney.org/) to find the chapter nearest you.

1. CHARCOT-MARIE-TOOTH DISEASE, DOMINANT INTERMEDIATE E; CMTDIE. http://omim.org/entry/614455[↩]