Dear,

It seems from the history you have provided us with that you suffered from Acute Glomerulonephritis along with each episode of renal infection that you were affected with. It would have been helpful to know more details as to what diagnosis was established during each episode, any ultrasound or other imaging results and a more comprehensive result of the urine and blood work performed at the time. 

Glomerulonephritis is a condition of the kidneys where it presents with various symptoms/signs of:

• mild hypertension
• proteinuria - passing proteins in the urine, but this is usually less than 3.5g/day. If this value is higher in your urine analysis then the diagnosis would change to Nephrotic Syndrome.
• hematuria - blood in the urine
• uraemia - which is a collective set of symptoms of fatigue, nausea, loss of appetite etc due to accumulation of metabolic waste products.

The pitting edema that you experience is due to significant loss of proteins in the urine. Normally, proteins present in the blood circulation, help in keeping the fluids within the blood vessels and not seep out into the surrounding tissue. When there is loss of proteins significantly, this mechanism is affected and the fluid seeps from the vessels into the surrounding tissues leading to a pitting edema. 

Now, the prognosis of glomerulonephritis depends on the condition causing, which in your case are the recurrent kidney infections. It is hard for me to provide you with more details as to what could be causing this repeated infection, without having known the above mentioned test results. However, I can help you educate yourself more about what possibilities there are so that you can discuss in detail with your consulting doctor.

• Some women are predisposed or have a tendency to develop recurrent urinary tract infections, and when this isn't treated on time, or progresses rapidly the infections can spread upwards. Am aware that you have mentioned that there have been no pre-existing UTIs, however, I would still like for you to go through these facts. Most kidney infections develop as a complication of cystitis (bladder infection). Bacteria causing cystitis can sometimes travel up to infect a kidney. The bacteria are usually those which live in your bowel. They can travel from the anus, up the urethra, into the bladder and cause a bladder infection. This infection can then travel up to cause a kidney infection. 

• Some kidney infections develop without a bladder infection. This is sometimes due to a problem in the kidney. For example, you are more prone to kidney infections if you have a kidney stone or an abnormality of your kidney.

So if your consulting doctor is absolutely sure that there have been no pre-existing UTIs or cystitis, then the other factors to be looked for are either stones, or a structural abnormality of your kidney. Make sure that these tests are done:

• Blood workup like Complete Blood Count, Renal Function Tests, Serum Albumin levels, Inflammatory markers like CRP and/or ESR
• Urine culture and analysis
• Ultrasound of kidney, ureter and bladder. Other imagining like CT with contrast if the renal function test is normal is more preferable. 

To help prevent worsening or precipitating further attacks, please follow the measures mentioned below:

• Don't hold on to urine when you feel the need to pass urine. Go to the toilet promptly.

• Make sure you drink plenty of fluids every day to keep yourself well hydrated. However, do not go above 4 - 5 L/day if you are hypertensive.

• Treat any constipation promptly, as constipation can increase your chances of a bladder or kidney infection. 

• Empty your bladder after having sex.

• Always make sure that you wipe from front to back after going to the toilet to pass faeces.

For more on glomerulonephritis please visit this site http://www.nlm.nih.gov/medlineplus/ency/article/000484.htm

To know more about pyelonephritis http://kidney.niddk.nih.gov/kudiseases/pubs/pyelonephritis/ and http://emedicine.medscape.com/article/245559-overview

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Take Care,

AskMDx Team