Glomerulonephritis: How to Diagnose and Prevent It at Various Levels

Glomerulonephritis is an inflammation of the glomeruli in the kidney. The glomeruli is constellation of small blood vessels in the kidney that act as a filter to remove excess fluid, electrolytes and nitrogenous wastes from the blood into the urine.

It is divided into:

Acute Glomerulonephritis- The symptoms develop suddenly.

Chronic Glomerulonephritis- The symptoms develop gradually.

In glomerulonephritis, the glomeruli lose their filtering capacity thus blood proteins and red cells are excreted in the urine in various quantities depending on the severity of the glomerular damage.

Accurate diagnosis is essential in the successful treatment of glomerulonephritis.

Diagnosis is highly dependent on the clarity of symptoms, examination and investigation findings.

· Passage of coca-colored urine due to the presence of red blood cells in the urine. This is called haematuria.

· Passage of foamy urine due to excess amount of proteins in the urine. This is called proteinuria.

· Presence of peri-orbital and ankle swelling.

· Peri-orbital and pedal edema.

· Elevated blood pressure.

· Urinalysis-This reveals diagnostic findings such as red blood cells, casts, white blood cells and proteins in the urine.

· Blood test- Blood level of electrolytes, urea and creatinine. This is mainly done to assess the extent of kidney damage.

· Radiological imaging tests-This is done usually when the blood tests suggest some level of kidney damage. E.g Renal scan or abdominal CT scan is done.

· Kidney biopsy- This entails using a clinical procedure to extract some pieces of kidney tissues for microscopic examination. This is the only test that confirms glomerulonephritis.

This is based on the following principles:

· Treat underlying health conditions quickly.

· Use of corticosteroids to reduce the degree of inflammation and immunological responses.

· Dialysis- This is used for individuals with acute kidney injury or kidney failure.

· Anti-hypertensives such as ACEI, ARBs- This is used to control hypertension in some selected individuals.

There are 3 levels of prevention namely: primary, secondary and tertiary.

The aim of this is to prevent the onset of glomerulonephritis.

It entails the following

· Throat swab should be done for suspected bacteria cause of sore throat. If streptococcus is suspected, oral penicillin should be commenced as soon as possible.

· Prompt treatment of individuals with bacteria endocarditis.

This involves early diagnosis and prompt treatment of glomerulonephritis.

It specifically entails the following:

· Routine urinalysis to be done periodically for individuals at risk of streptococci infections and for individuals greater than 40 years.

· Periodic monitoring of blood urea and creatinine levels should be done for individuals with compromised kidney function.

This involves activities and interventions put in place for individuals with glomerulonephritis from developing complications such as kidney failure and to reduce the disease progression.

· Optimal control of co-morbidities like hypertension and diabetes mellitus.

· Reduce intake of high protein diet.

· Restrict salt intake.

· Cessation of smoking.

· Regular clinic follow up by a Nephrologist.

Finally, glomerulonephritis is a very lethal kidney disease of which the onset and progression can be prevented if an individual adheres to the activities in the various levels of prevention highlighted above.

The Role Of The Brain In Addiction

Technology has its mighty hand over every field in the world now. And since the base of technology is science, so how could medical sector not undergo changes! Neuroscience has always been an area of immense complexities and curiosities. Advances in this sector has allowed doctors to dig deeper into the brain and even study minutest of changes that happen due to substance intake.

When we talk about addiction as a brain disease, the reward system of the brain plays a very important role.

Physiologically, limbic system is the brain’s reward system. Mesolimbic and mesocortical pathways (Mid-brain) have our cognitive control and functions which would be both reward related and aversion related. Reward related functions are always stronger and more motivating than aversion, hence drug abuse behavior is stronger in addicts. The reward system connects certain structures in such a way that they generate the feeling of pleasure for certain behaviors or stimulus given to the body. In day-to-day life, it is activated by healthy, life-sustaining activities like eating and socializing. But ‘Drug Abuse’ is another behavior that generates euphoria, which is enjoyed by the mind. And human nature is to repeat those actions that give us some definite satisfaction. The limbic system does more than just giving a reward response. For any behavior to be reinforced, it has to be first registered as pleasant to the mind and body. Limbic system in the brain recognizes our positive and negative emotions, which very well explains, how our body and mind get dependent on any psychoactive mood altering substance.

However, with recent developments, neurobiology has been able to study how addiction is related to the brain. Researchers and scientists studied the brain’s reaction to different substances and discovered that drug abuse actually alters the chemical makeup of the brain, which is what causes addiction and they named it as a ‘Brain Disease.’

Since the brain is placed as the epicenter of human activity, it is the initiation point of every phenomenon that occurs. Whatever we feel, experience or think, all is first registered by the brain and within lesser than nanoseconds, it commands us to act. It communicates through neurons, neurotransmitters, receptors and transporters. Yes, it is very complicated and sounds mystical too (specially to people like me who have not studied biology after high school)

How do Drugs Affect the Brain?
Psychoactive substances interrupt with the communication systems of the brain. They interfere with the way a message is transmitted and sent to its defined destination. No matter how much people say that cannabis would not be called a drug, it is a plant, but the reality remains unchanged, which is, that everything has certain chemical composition. For example, Heroin and Marijuana’s chemical structure are like copies of a natural neurotransmitter. Amphetamines mimic catecholamine neurotransmitters, causing general physiological changes which prepare the body for physical activity and fight-or-flight response. So, the moment the body is intoxicated with a drug containing amphetamines or its derivatives, it starts reacting in unnatural ways by raising blood pressure, increased alertness resulting in sleeplessness, blood glucose levels. They can easily activate neurons, giving various directions to the body to react in a different way, than would a natural neurotransmitter would! Cocaine can make a person delirious, because it releases natural neurotransmitters in bulk and blocks the natural recycling process of neurotransmitters by the brain. Amphetamine causes drug tolerance very quickly and rapidly too.

Chronic addictive drug use causes alterations in the process by which information from a gene is used to synthesize a gene product- RNA or Protein. Nigrostriatal Pathway is a dopaminergic pathway that plays an extensive and unavoidable role in addiction. It comprises of Transcription Factor, which is a protein that controls what all information has to go from the DNA to the messenger RNA. Psychoactive substances block, many of the neural and behavioral alterations that are to be taken to the RNA. Altered dopamine transmission is the first thing that comes to notice in cases of drug abuse.

These have been many studies extensively done by medical science researchers on addiction. There is a wide range of chemicals that people use to reach a euphoric state. But the gist of it all is, that they play with the normal functioning of brain by altering the natural chemicals that ought to be there.

How Does the Reward System Work?
Whenever a person happens to do something that takes him to a different state of mind for a while, like reaching the oomph point in a sexually pleasurable activity, treating the taste buds with a new and a very different flavor or winning an excessive amount of money or any other valuable resource that he could use to be really rich, the brain takes it all in the same way. It activates the same gland and releases the same chemical Dopamine, which functions as a neurotransmitter, in all scenarios that seem to be pleasurable or exciting. Similarly, whenever the body receives an antibody that becomes too exciting for it like any drug, chemical or alcohol, the body releases certain amount of dopamine or cuts down its level. It is a problematic scenario is there is too much or too little of dopamine released by the brain. Drugs are addictive because they release up-to 10 times more dopamine than a natural neurotransmitter can! But when the body gets tolerant to the same drug and its amount, it can even cut down its normal release of dopamine!

Analysis to Next Generation Sequencing Technology

With the development of science, traditional Sanger sequencing has failed to meet new requirements of low cost, high throughput and fast in speed.

Recent years, with the discovery and promotion of second-generation sequencing technology, the gene sequencing speed has increased greatly while achieving a substantial decline in costs, making large-scale application of genome sequencing possible. Now, the cost of personal whole genome sequencing is about 5,000$, and is expected to decreased to less than $ 1,000 in the next few years.

The rapid development of sequencing technology will promote the massive accumulation of DNA sequencing data, accompanied by the accumulation of the corresponding individual diseases, signs and other data at the same time. When we accumulate enough data, how to understand these data will be critical. On the micro level, generations of molecular biologists’ studying the effects of apparent biological traits genes exert on utilizing technologies like gene knockout have made breakthroughs in many crucial aspects. On the macro level, statistics and other data analysis techniques are introduced to study the relationship between gene sequences and biological phenotype. The accumulation of basic scientific research gradually brings breakthroughs in clinical applications.

There are now two types of clinical applications mainly, one aims at disease screening of ordinary people. It infers people’s future risks of getting cancer by measuring the known genes associated with a disease loci. The other aims at the diagnosis cancer and other deadly diseases. It finds in a series of drugs or plans the most effective one for certain patients by testing the loci of certain genes.

Data from BBC research shows that total global gene sequencing market increased from $ 7.941million in 2007 to $ 4.5 billion in 2013, and will reach $ 11.7 billion in the year of 2018 with the CAGR up to 21.2%.

Currently, the market of de novo sequence platform is mainly taken by several major manufacturers, including the Illumina, Ion Torrent / Life Technologies (was the acquisition of Thermo Fisher in 2014), 454 Life Sciences / Roche, etc.

Under such a circumstance, the next generation sequencing technology (second-generation sequencing) appears. As an emerging industry, the next-generation sequencing technology can be applied in clinical testing like antibody discovery, health industry, industrial and agricultural use of gene-oriented study as well as scientific research and development.

To stimulate the next generation sequencing market, we need to start by investing more small and medium size industry focusing on this field.