Bright's Disease

What is Bright’s disease?

Bright’s disease is an old word used for a disease that is today known as glomerulonephritis or simply nephritis. This disease occurs when there is inflammation in the parts of the kidney that produce urine, known as the glomeruli and the nephron¹

Bright's disease was named after Dr. Richard Bright, an English physician who was recognized for discovering the disease

Glomerulonephritis or nephritis can either be subacute, acute, or chronic. 

Acute glomerulonephritis has a sudden onset and can go away without treatment, or in cases where it doesn’t, prompt treatment can prevent long-term damage to the kidney. Subacute nephritis is a stage that usually occurs before the acute phase. 

Chronic nephritis, on the other hand, has a more gradual onset and progresses over a long period of time with little or no symptoms. This can harm your kidneys in an irreparable way, eventually leading to renal failure. In the US, about 6 million people aged 18 years and above suffer from kidney diseases, and about 52,547 die from either nephritis, nephrotic syndrome, or nephrosis.⁴ 

Signs and Symptoms

Stages: acute, subacute, chronic

The signs and symptoms of glomerulonephritis depend on whether it is subacute, acute, or chronic. 

A person suffering from subacute glomerulonephritis has an enlarged kidney with a smooth and pale surface. The internal tissue of the kidney becomes darker than normal.⁵  

The signs and symptoms of acute glomerulonephritis include puffiness of the face, urinating less frequently, dark rust-colored urine due to blood in urine, coughing, and high blood pressure. 

Chronic glomerulonephritis is manifested by excess blood or protein in the urine, high blood pressure, swelling of the ankles and face, frequent urination at night, urine with foam or bubbles, abdominal pain, and frequent nosebleeds. 

Apart from these signs and symptoms, one can develop complications from the disease. Complications in glomerulonephritis may result in kidney failure, which is manifested through fatigue, lack of appetite, nausea and vomiting, lack of sleep, dry itchy skin, and muscle cramps at night.⁶ Other complications include high blood pressure and nephrotic syndrome. 

Risk factors

The causes of glomerulonephritis are usually unclear. However, there are some risk factors associated with the likelihood of the diseases. Streptococcal infections of the throat or skin infection (impetigo) can cause post-streptococcal glomerulonephritis. Other infectious diseases such as tuberculosis (TB) and syphilis can lead to glomerulonephritis. A bacterial infection of the heart valves known as bacterial endocarditis has also been found to be a risk factor for glomerulonephritis. 

Furthermore, viruses such as HIV, hepatitis B, and hepatitis C have been implicated in increased risk of glomerulonephritis. Most particularly, diseases such as strep throat, lupus, Goodpasteur syndrome, amyloidosis, granulomatosis with polyangiitis, and polyarteritis nodosa, coupled  with the heavy use of nonsteroidal anti-inflammatory drugs, such as ibuprofen (Advil) and naproxen (Aleve), are risk factors for acute glomerulonephritis.⁶ 

Treatment

Generally, mild cases are self-limiting, meaning they improve on their own. In cases where treatment is needed, the treatment will be administered depending on the kind of glomerulonephritis and severity. Mild cases generally require dietary changes. It may be required that one reduces the intake of food that is rich in salt. Also, drinks that contain high potassium and fluids should be reduced. These measures are taken to control blood pressure and to regulate the amount of fluid in the body. 

It is recommended that one stops smoking, as smoking exacerbates kidney disease caused by glomerulonephritis. More severe cases of glomerulonephritis caused by immune system problems are treated with immunosuppressants. Steroids such as prednisolone are an example of immunosuppressants. They reduce swelling and their dose is generally reduced when the kidney starts to recover or they are totally stopped.⁷ 

Glomerulonephritis that leads to increase in blood pressure is treated with medicines that lower the blood pressure and the amount of proteins that leaks into the blood. These medicines include angiotensin-converting enzyme (ACE) inhibitors and angiotensin receptor blockers (ARB). 

In very chronic cases of kidney disease, kidney dialysis may be performed or a complete kidney transplant done.⁷ 

Conclusion

 In summary, Bright’s is an old name of a disease that is today known as glomerulonephritis or simply nephritis. It is caused by the inflammation of the tiniest tubes that filter the blood and produce urine, known as the glomerulus. This inflammation can either be due to a bacterial or viral infection. The disease manifests through colored or foamy urine, enlarged kidneys, swelling of the face, high blood pressure, and vomiting. The disease can be treated with dietary changes, immunosuppressants, dialysis, diuretics, and in the worst-case scenario, a kidney transplant.