Introduction 

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Although glomerulonephritis is a rare disease, it is the commonest cause  of end-stage renal failure in most countries. It is possible to live a normal life even with a substantial reduction of renal function, but when the function goes down below ten per cent of normal, symptoms such as muscular weakness, tiredness, itching, anemia and nausea may eventually invalidate the patient seriously. This condition is called end-stage renal disease and may soon become life-threatening.

Previously, all patients with end-stage renal disease died, but to-day it is possible to maintain life by dialysis treatment or by transplanting a kidney from another human being. However, it is still a catastrophe for the patient and the patient´s family because there is a great shortage of kidneys for transplantation, and dialysis treatment is disabling. Two to three times a week the patient is chained to a dialysis machine for many hours and despite that the patient`s health is not optimal. A tedious diet and many drugs are necessary to combat the many complications of end-stage renal failure and the mortality is high. Every year 20-30 per cent of all dialysis patients die, but new patients constantly arrive. Therefore, although glomerulonephritis is a rare disease it is costly for society. In many countries treatment of renal failure alone takes four to five per cent of the total health budget.

Glomerulonephritis is an innocent condition as long as the renal function is normal. The “patient” has no symptoms and the diagnosis may remain undetected unless his urine is examined. Here, a routine laboratory test may reveal the presence of small amounts of protein and blood in the urine (named proteinuria and hematuria, respectively), and with a microscope red blood cells and casts of the renal tubules may be seen also. If a patient with these findings is admitted to a renal department for further investigations it is likely that the doctor with a fine syringe will take out a small sample of the kidney tissue, a so-called kidney biopsy. A microscopic analysis of the kidney tissue most often, but not always, will reveal deposits of immunoglobulins and/or complement factors in the glomeruli, the minute filters of the kidney. In spite of these laboratory abnormalities the “patient” may remain healthy for the rest of his life.  

I have guarded the word patient with quotation marks because, as I shall argue in the following, it is doubtful if the presence of immune components in the glomeruli alone, or the findings of slight urine anomalies, is a disease. 

Glomerulonephritis may also appear acutely, often in association with an upper respiratory infection, but even spontaneously. Acute glomerulonephritis has usually a benign course, even in cases where the renal function is seriously affected in the acute stage, as the function recovers completely in most patients. 

But in some patients glomerulonephritis may be associated with the nephrotic syndrome, a high blood pressure and a decreased renal function. If these complications do not occur in association with an acute onset as described above, but rather appear gradually and insidiously, these abnormalities will most often, sooner or later, proceed to end-stage renal failure. 

This is the greatest challenge for researchers in nephrology to-day, to understand why, once renal function has worsened, most cases of glomerulonephritis and other diseases of the kidney tissue progress to end-stage renal failure, irrespective of any treatment.

In the following I shall present a hypothesis, that explains the cause of progressive renal failure in many patients, a hypothesis that is based on solid scientific evidence, but is ignored or met by disbelief by most nephrologists.

The aim of the website is not only to inform colleagues, but also  patients and their relatives. Therefore I have tried to present the text in a way so that it should become understood by a layman. Certain scientific terms are explained on a separate file. These words are marked as hyperlinks - just click on it and use the back button to get back to the text. Here I have also given references to the relevant scientific literature. If you are unfamiliar with the way scientists present or search information, but are interested in deepening your knowledge, go to a university library with the references and ask the librarian for help.

Next section: What is the cause of glomerulonefritis?