How to Understand Bright's Disease

Bright's disease is an older term for the broad diagnostic category now called glomerulonephritis. This is a condition with multiple underlying causes, all of which are characterized by injury and inflammation to the main (microscopic) filtration structure of the kidney called the glomerulus. Glomerulonephritis generally presents as a constellation of findings that include hematuria (blood in the urine either gross or microscopic), proteinuria (protein in the urine), edema (swelling of the body), and often hypertension (high blood pressure). Understanding what glomerulonephritis or Bright's disease is can help you determine whether you or someone you know may have a family history of kidney disease.


Part 1
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Understanding Bright's Disease (Glomerulonephritis)

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  1. Though initially named after the disease's discoverer, the term "Bright's disease" has largely been removed from contemporary medical literature and discussions of kidney disease — in fact, your doctor might not know what you are referring to if you use it. Instead, Bright's disease as a diagnosis has been superseded by the contemporary medical terms "nephritis" or "glomerulonephritis" (GN). [1]
    • The term Bright's disease is most often found today by people researching their genealogy.
  2. There are two types of GN: acute and chronic. Acute GN may be caused by some other illness like strep throat or granulomatosis with polyangiitis. [2] Chronic GN can run in families, but often the cause is not known. A person may suffer an acute attack and then develop chronic GN later on. Other causes may include: [3] [4]
    • Lupus
    • Bacterial endocarditis
    • Viral infections (such as (HIV, hepatitis B, and hepatitis C)
    • Goodpasture's syndrome
    • Polyarteritis
    • Diabetic kidney disease
    • Focal segmental glomerulosclerosis
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  3. Chronic kidney diseases affect the kidney's ability to function at a normal, healthy level. The loss of kidney function has subsequent effects on the rest of the body, including the body's ability to: [5]
    • Filter waste out of the blood
    • Maintain normal blood pressure
    • Produce vitamin D
    • Produce erythropoietin, which helps produce red blood cells
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Part 2
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Diagnosing Bright's Disease (Glomerulonephritis)

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  1. GN has some variance of symptoms, depending on the particular causes and conditions of the disease; however, the typical symptoms include: [6] [7]
    • Pink or cola-tinted urine, caused by red blood cells in the urine
    • Foam in the urine caused by excessive protein content
    • High blood pressure
    • Fluid retention, especially in the face, hands, feet, and abdomen
    • Weight gain (mainly caused by fluid retention)
    • Fatigue, usually accompanied by anemia and/or kidney failure
  2. In addition to the presence of telling physical symptoms, there are a number of tests that can confirm a diagnosis of GN. Common tests include the following: [8]
    • Urine analysis to check for red and white blood cells, increased protein levels, or increased levels of creatinine and urea
    • Blood tests to measure for levels of waste products like creatinine and blood urea nitrogen
    • Ultrasound
    • Biopsy of the kidney
  3. Kidney disease is categorized as a chronic and progressive disease. Each stage of the disease is marked by its own symptoms and the gradual loss of kidney function, measured by the kidney's Glomerular Filtration Rate (GFR). [9] The stages of kidney disease are:
    • Stage one — Marked by mild symptoms and normal GFR of at least 90 percent of normal kidney function.
    • Stage two — Marked by mild symptoms and reduced GFR, with the gradual reduction of kidney function to between 60 and 89 percent of normal function.
    • Stage three — Marked by moderate symptoms and significantly reduced GFR, with kidney function ranging between 40 and 59 percent of normal function.
    • Stage four — Marked by severe symptoms and drastically reduced GFR, with kidney function ranging between 15 and 29 percent of normal function.
    • Stage five — The kidneys operate at less than 15 percent of normal function.
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Part 3
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Treating Bright's Disease (Glomerulonephritis)

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  1. Because many cases of GN are caused by underlying conditions, your treatment plan may include treating those conditions. This treatment plan will vary, depending on what conditions are causing your kidney disease. [10] Talk to your doctor about your condition, and understand how it may impact your kidney health.
  2. Medications like corticosteroids can help decrease immune system responses like inflammation, which is a common problem for people with kidney diseases and disorders; however, corticosteroid use carries the risk of significant side effects, including increased appetite/weight gain, sudden and significant mood swings, delayed healing of injuries, weakened bones, diabetes, and high blood pressure.
  3. Chronic kidney diseases often affect the body's ability to regulate its blood pressure. Because of this, many treatment plans include taking blood pressure medication. In addition to regulating the body's blood pressure, these medications can also reduce the amount of protein released through your urine, which may help you manage the symptoms of the disease. [11]
    • Common blood pressure medications prescribed to treat kidney diseases like GN include benazepril (Lotensin), captopril (Capoten), and enalapril (Vasotec).
    • Some doctors may also prescribe angiotensin II receptor blockers like losartan (Cozaar) and valsartan (Diovan) to achieve similar results.
  4. Diuretics like water pills can help reduce water retention. Decreasing water retention will help manage swelling in the body and can increase your kidneys' ability to function by increasing water output. [12]
    • Common water pills prescribed for kidney diseases include furosemide (Lasix) and spironolactone (Aldactone).
  5. Blood thinners, also known as anticoagulants, reduce your blood's ability to form clots, which may help prevent blood clots in your body (specifically the kidneys). [13] This may help manage the symptoms of kidney disease and improve your kidneys' ability to function.
    • Common anticoagulants prescribed to treat kidney diseases include heparin and warfarin (Coumadin).
  6. The efficacy of taking cholesterol medication (also known as statins) for kidney disease is unclear; however, some studies suggest that taking cholesterol medications may help reduce the risk of death in some people. [14]
    • Commonly-prescribed statins for people with kidney diseases include atorvastatin (Lipitor), fluvastatin (Lescol), and lovastatin (Altoprev, Mevacor).
  7. There is no known way to prevent all types of kidney disease. But some studies suggest that practicing good hygiene — including engaging in safe sex and refraining from intravenous drug use — may help prevent viral infections (such as hepatitis and HIV) that could eventually lead to chronic kidney disease. [15]
  8. Some people find that making dietary changes can help manage some of the symptoms of GN. Common dietary recommendations for people with kidney diseases include: [16] [17]
    • Choosing lean protein over fatty proteins
    • Lowering the overall consumption of fat and cholesterol in the diet
    • Maintaining a low-salt diet
    • Reducing potassium in the diet
    • Maintaining a healthy, manageable body weight
    • Avoiding smoking
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Expert Q&A

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  • Question
    My husband had Bright's disease as a child (around age seven to eight). He has now developed congestive heart failure at age 59, although he has been extremely health until now, with no heart problems ever... Could the CHF be a result of the Bright's disease?
    Mark Ziats, MD, PhD
    Internal Medicine Physician
    Dr. Mark Ziats is an Internal Medicine Physician, Scientist, Entrepreneur, and the Medical Director of xBiotech. With over five years of experience, he specializes in biotechnology, genomics, and medical devices. He earned a Doctor of Medicine degree from Baylor College of Medicine, a Ph.D. in Genetics from the University of Cambridge, and a BS in Biochemistry and Chemistry from Clemson University. He also completed the INNoVATE Program in Biotechnology Entrepreneurship at The Johns Hopkins University - Carey Business School. Dr. Ziats is board certified by the American Board of Internal Medicine.
    Mark Ziats, MD, PhD
    Internal Medicine Physician
    Expert Answer
    Possibly. it wouldn't be directly caused by it, but could be contributed to by uncontrolled high blood pressure for years (that would have been caused by Bright's). Also possible they are unrelated as CHF is very common.
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  • Question
    Could cocaine use have caused Bright's Disease?
    Mark Ziats, MD, PhD
    Internal Medicine Physician
    Dr. Mark Ziats is an Internal Medicine Physician, Scientist, Entrepreneur, and the Medical Director of xBiotech. With over five years of experience, he specializes in biotechnology, genomics, and medical devices. He earned a Doctor of Medicine degree from Baylor College of Medicine, a Ph.D. in Genetics from the University of Cambridge, and a BS in Biochemistry and Chemistry from Clemson University. He also completed the INNoVATE Program in Biotechnology Entrepreneurship at The Johns Hopkins University - Carey Business School. Dr. Ziats is board certified by the American Board of Internal Medicine.
    Mark Ziats, MD, PhD
    Internal Medicine Physician
    Expert Answer
    Probably not as its thought to be an autoimmune disease, although it could contribute/make it worse by causing decreased blood flow to the kidneys.
    Thanks! We're glad this was helpful.
    Thank you for your feedback.
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      Warnings

      • Historical treatments for glomerulonephritis or Bright's disease, such as hot baths and fasting, are not intended to represent how doctors treat kidney disease today. Understanding these treatments may be useful for people researching their family history, but should not be used as treatment methods. The treatments listed in this article reflect the current medically-accepted methods of treating kidney diseases.
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      • While the term "Bright's disease" is no longer in use, the symptoms of kidney disease are still real, and very serious. If you experience any of the symptoms described above, see your doctor immediately.
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      References

      1. ↑ https://www.kidney.org/atoz/content/glomerul
      2. ↑ https://www.kidney.org/atoz/content/glomerul
      3. ↑ http://www.mayoclinic.org/diseases-conditions/glomerulonephritis/basics/causes/con-20024691
      4. ↑ https://www.kidney.org/atoz/content/glomerul
      5. ↑ http://www.nhs.uk/conditions/kidney-disease-chronic/pages/introduction.aspx
      6. ↑ http://www.mayoclinic.org/diseases-conditions/glomerulonephritis/basics/symptoms/con-20024691
      7. ↑ http://www.mayoclinic.org/diseases-conditions/nephrotic-syndrome/basics/definition/CON-20033385?p=1
      8. ↑ http://www.mayoclinic.org/diseases-conditions/glomerulonephritis/basics/tests-diagnosis/con-20024691
      9. ↑ http://www.nationalkidneycenter.org/chronic-kidney-disease/stages/
      1. ↑ https://www.mayoclinic.org/diseases-conditions/nephrotic-syndrome/diagnosis-treatment/drc-20375613
      2. ↑ https://www.mayoclinic.org/diseases-conditions/nephrotic-syndrome/diagnosis-treatment/drc-20375613
      3. ↑ https://www.mayoclinic.org/diseases-conditions/nephrotic-syndrome/diagnosis-treatment/drc-20375613
      4. ↑ https://www.mayoclinic.org/diseases-conditions/nephrotic-syndrome/diagnosis-treatment/drc-20375613
      5. ↑ https://www.mayoclinic.org/diseases-conditions/nephrotic-syndrome/diagnosis-treatment/drc-20375613
      6. ↑ https://www.kidney.org/atoz/content/glomerul
      7. ↑ https://www.mayoclinic.org/diseases-conditions/nephrotic-syndrome/diagnosis-treatment/drc-20375613
      8. ↑ http://www.mayoclinic.org/diseases-conditions/glomerulonephritis/basics/lifestyle-home-remedies/con-20024691

      About This Article

      Article Summary X

      Bright's disease, also known as nephritis or glomerulonephritis (GN), is best understood as an acute or chronic condition that affects the kidneys. If you have an illness such as Lupus, strep throat, or Goodpasture's syndrome, you could develop acute GN. Alternatively, you may develop chronic GN if it runs in your family or if you've suffered from an acute attack in the past. Because chronic kidney diseases affect the kidney's ability to function, make sure you talk to your doctor if you think you have Bright's disease. Tell them about any symptoms you've experienced, including pink or brown urine, foaming urine, fluid retention, weight gain, or fatigue. Your doctor will most likely perform a urine analysis and blood test, but may also want to do an ultrasound or biopsy of your kidney. For more tips from our Medical co-author, including how to recognize the stages of kidney disease, scroll down.

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