Glomerulonephritis: Diagnosis, Symptoms, and Treatment Options

Introduction

Glomerulonephritis is a kidney condition that specifically targets the glomeruli—tiny, essential filters in the kidneys responsible for removing waste products and excess fluid from the bloodstream. This condition can appear suddenly (acute) or develop gradually over time (chronic), potentially leading to kidney damage or even kidney failure if left untreated. Historically, glomerulonephritis has been recognized as one of the leading causes of kidney-related illnesses worldwide. Fortunately, advancements in medical research have greatly improved our understanding of its causes and treatment options.

As a telemedicine practice, we are dedicated to providing accessible and compassionate care for individuals managing conditions like glomerulonephritis. This article is designed to help you better understand your diagnosis, including its risk factors, symptoms, diagnostic methods, treatment options, and self-care strategies. By empowering you with knowledge, we aim to support your journey toward better health and well-being.

What is Glomerulonephritis?

Glomerulonephritis is a kidney disorder characterized by inflammation of the glomeruli. Several factors can increase the risk of developing this condition, including lifestyle habits, medical history, genetic predisposition, and age. Common symptoms include swelling, blood in the urine, and proteinuria (excess protein in the urine). Diagnosis typically involves blood and urine tests, along with kidney biopsies. Treatment options vary and may include medications, medical procedures, and self-care strategies, all aimed at relieving symptoms and preventing complications.

Description of Glomerulonephritis

Glomerulonephritis occurs when the glomeruli, the kidney’s microscopic filtering units, become inflamed. This inflammation can impair the kidneys’ ability to efficiently filter waste, excess fluids, and toxins from the blood. The condition can be triggered by infections, autoimmune diseases, or other underlying health issues. In some cases, however, the exact cause remains unknown.

Glomerulonephritis can present in two forms: acute, where symptoms appear suddenly, or chronic, where the condition develops gradually over months or even years. Acute cases often improve with timely treatment, while chronic glomerulonephritis can lead to long-term kidney damage and, in severe instances, kidney failure.

Globally, glomerulonephritis is a major contributor to kidney disease. According to the National Kidney Foundation, it is one of the leading causes of end-stage renal disease (ESRD), affecting millions of people each year. Early diagnosis and prompt treatment are critical for effectively managing this condition and preventing serious complications.

Risk Factors for Developing Glomerulonephritis

Lifestyle Risk Factors

Certain lifestyle choices can increase the likelihood of developing glomerulonephritis. For example, infections such as strep throat or hepatitis can trigger an immune response that leads to kidney inflammation. Poor hygiene and living in crowded conditions may heighten the risk of these infections. Additionally, the use of recreational drugs or prolonged exposure to harmful toxins can damage the kidneys and contribute to this condition.

Adopting a healthy lifestyle, including maintaining good hygiene and avoiding harmful substances, can significantly reduce your risk. Seeking prompt medical care for suspected infections is also essential to prevent complications.

Medical Risk Factors

Underlying medical conditions can also increase the risk of glomerulonephritis. Autoimmune diseases such as lupus or Goodpasture syndrome may cause the immune system to mistakenly attack the kidneys. Similarly, chronic conditions like diabetes and high blood pressure can damage the kidneys over time, making them more susceptible to inflammation.

Infections, including bacterial endocarditis (a heart infection) and viral infections like HIV, are additional potential triggers. Individuals with a history of kidney disease or those undergoing treatments such as chemotherapy are also at higher risk.

Regular monitoring and effective management of these conditions can help lower the risk of kidney complications, including glomerulonephritis.

Genetic and Age-Related Risk Factors

Genetics and age also play a role in the development of glomerulonephritis. A family history of kidney disease may increase your risk, as certain genetic mutations can predispose you to kidney inflammation. Inherited conditions like Alport syndrome, which directly affects the glomeruli, can also lead to glomerulonephritis.

Age is another important factor. Acute post-streptococcal glomerulonephritis is more common in children, while chronic forms are more frequently observed in adults. Older adults face higher risks due to age-related declines in kidney function and the presence of other chronic health conditions.

Understanding your genetic and age-related risks allows you and your healthcare provider to take proactive steps to monitor and protect your kidney health.

Clinical Manifestations of Glomerulonephritis

Hematuria (Blood in Urine)

Hematuria, or the presence of blood in the urine, is a hallmark symptom of glomerulonephritis, occurring in 60-80% of patients. It is often one of the earliest signs of the condition. Hematuria can be microscopic (detectable only under a microscope) or macroscopic (visible to the naked eye, giving urine a reddish or tea-colored appearance). This occurs when inflamed glomeruli allow red blood cells to leak into the urine. Hematuria is more common during the acute phase and may improve with treatment or as the condition progresses.

Proteinuria (Excess Protein in Urine)

Proteinuria, or the presence of excess protein in the urine, affects 40-70% of individuals with glomerulonephritis. Under normal circumstances, the glomeruli prevent large molecules like proteins from entering the urine. However, when the glomeruli are inflamed or damaged, proteins such as albumin can leak into the urine, causing it to appear foamy or frothy. Proteinuria is often associated with nephrotic syndrome, a severe form of glomerulonephritis, and can lead to complications such as low blood protein levels and swelling (edema).

Edema (Swelling)

Edema, or swelling, is observed in 50-60% of individuals with glomerulonephritis. It is most noticeable in areas such as the face, hands, feet, and ankles. This swelling occurs due to fluid retention, as the kidneys lose their ability to effectively filter and excrete excess water and sodium. Additionally, protein loss through urine can lower oncotic pressure in blood vessels, causing fluid to leak into surrounding tissues. Edema is often more pronounced in the mornings and may worsen as the condition advances.

Hypertension (High Blood Pressure)

Hypertension, or high blood pressure, affects 30-50% of individuals with glomerulonephritis. The kidneys play a crucial role in regulating blood pressure by managing fluid and electrolyte balance. When the glomeruli are damaged, the kidneys may retain excess sodium and water, leading to increased blood volume and pressure. If left untreated, hypertension can further harm the kidneys, creating a harmful cycle.

Fatigue

Fatigue is a common but nonspecific symptom, reported by 40-50% of individuals with glomerulonephritis. It is caused by reduced kidney function, anemia (a low red blood cell count), and the body’s inflammatory response. The buildup of waste products in the blood (uremia) also contributes to feelings of tiredness and low energy. Fatigue is often more pronounced in advanced stages but can occur at any point in the disease.

Decreased Urine Output

Decreased urine output, or oliguria, is observed in 20-30% of patients, particularly in acute or severe cases. This occurs when inflammation and damage to the glomeruli reduce the kidneys’ ability to filter blood and produce urine. Patients may notice a significant drop in daily urine volume. Oliguria is a sign of impaired kidney function and requires immediate medical attention.

Foamy Urine

Foamy urine, reported by 30-40% of individuals with glomerulonephritis, is often a sign of proteinuria. Proteins like albumin reduce the surface tension of urine, creating bubbles. While dehydration or rapid urination can also cause foaminess, persistent foaminess should be evaluated by a healthcare provider to rule out kidney disease. This symptom is more common in cases of nephrotic syndrome.

Abdominal Pain

Abdominal pain affects 10-20% of individuals with glomerulonephritis. It may result from inflammation of surrounding tissues or complications such as kidney swelling or blood clots in the renal veins. The pain is often described as dull or aching and may be localized to the flanks or lower back. While not specific to glomerulonephritis, abdominal pain in combination with other symptoms can raise suspicion for the condition.

Joint Pain

Joint pain, or arthralgia, occurs in 15-25% of individuals, particularly those with autoimmune-related forms of glomerulonephritis, such as lupus nephritis. This symptom is caused by systemic inflammation, which can affect multiple organs, including the joints. Joint pain may be accompanied by swelling, stiffness, or redness and is often worse in the morning or after periods of inactivity.

Rash

Rashes are observed in 10-15% of glomerulonephritis cases, especially in conditions like IgA vasculitis or lupus nephritis. These rashes may appear as red or purple spots (purpura) on the skin, often on the lower extremities. The rash results from inflammation of small blood vessels (vasculitis) or immune complex deposits in the skin. While not specific to glomerulonephritis, a rash in conjunction with other symptoms can aid in diagnosis.

Health Conditions with Similar Symptoms to Membranoproliferative Glomerulonephritis (MPGN)

Acute Kidney Injury (AKI)

Acute kidney injury (AKI) is a sudden loss of kidney function, impairing the kidneys’ ability to filter waste and regulate fluid and electrolyte balance. This rapid decline can occur within hours or days and is often triggered by factors such as severe dehydration, infections, certain medications, or reduced blood flow to the kidneys.

How to Differentiate Acute Kidney Injury from MPGN

Both AKI and membranoproliferative glomerulonephritis (MPGN) can present with swelling (edema), decreased urine output, and elevated levels of waste products in the blood. However, AKI typically develops abruptly and is often linked to a specific event, such as dehydration, major surgery, or an infection. In contrast, MPGN progresses more gradually and is frequently associated with immune-related kidney disorders.

Nephrologists may use blood tests to measure creatinine and blood urea nitrogen (BUN) levels, which are elevated in both conditions. However, urinalysis in AKI often reveals fewer red blood cells or less protein compared to MPGN. Imaging studies, such as ultrasounds, can help identify structural abnormalities or blockages in AKI, while a kidney biopsy is usually required to confirm MPGN. Prompt treatment of AKI, particularly when caused by dehydration or reduced blood flow, often leads to rapid recovery, whereas MPGN requires specialized treatment targeting the underlying glomerulonephritis.

Nephrotic Syndrome

Nephrotic syndrome is a kidney disorder characterized by excessive protein loss in the urine (proteinuria), low protein levels in the blood, swelling (especially in the legs and around the eyes), and elevated cholesterol levels. It occurs due to damage to the kidney’s tiny blood vessels, which are responsible for filtering waste and excess water.

How to Differentiate Nephrotic Syndrome from MPGN

Both nephrotic syndrome and MPGN can cause swelling and proteinuria. However, nephrotic syndrome is distinguished by extremely high levels of protein in the urine (exceeding 3.5 grams per day), whereas MPGN often involves both protein and blood in the urine. Swelling in nephrotic syndrome tends to be more severe and widespread, while in MPGN, it may be milder and more localized.

Blood tests in nephrotic syndrome typically show low albumin levels and high cholesterol, findings that are not commonly associated with MPGN. A kidney biopsy is crucial for diagnosing nephrotic syndrome and identifying its underlying cause. If you notice foamy urine (a sign of high protein levels) and significant swelling, nephrotic syndrome is more likely than MPGN.

Urinary Tract Infection (UTI)

A urinary tract infection (UTI) is a bacterial infection that affects parts of the urinary system, such as the bladder, urethra, or kidneys. Common symptoms include a burning sensation during urination, frequent urination, and cloudy or foul-smelling urine.

How to Differentiate a UTI from MPGN

Both UTIs and membranoproliferative glomerulonephritis can cause changes in urine appearance, such as cloudiness or discoloration. However, UTIs are often accompanied by symptoms like a burning sensation during urination, pelvic pain, and an urgent need to urinate—symptoms that are not typical of MPGN.

Urinalysis can help distinguish between the two conditions. In a UTI, the urine may contain bacteria, white blood cells, and nitrites, while MPGN is more likely to show red blood cells, red blood cell casts, and protein. UTIs are usually treated with antibiotics, leading to rapid symptom relief, whereas MPGN requires more complex management involving nephrology specialists.

Systemic Lupus Erythematosus (SLE)

Systemic lupus erythematosus (SLE) is an autoimmune disease in which the immune system mistakenly attacks the body’s tissues, causing inflammation and damage to various organs, including the kidneys, skin, joints, and heart.

How to Differentiate SLE from MPGN

Both SLE and membranoproliferative glomerulonephritis can cause kidney inflammation, leading to symptoms such as swelling, high blood pressure, and protein in the urine. However, SLE often presents with systemic symptoms, including joint pain, a butterfly-shaped rash on the face, fatigue, and sensitivity to sunlight, which are not seen in isolated MPGN.

Blood tests for SLE typically detect antinuclear antibodies (ANA) and specific markers like anti-dsDNA or anti-Smith antibodies. A kidney biopsy may reveal lupus nephritis, a distinct form of kidney inflammation caused by SLE, which differs from the patterns seen in MPGN. If you experience widespread symptoms affecting multiple organs, SLE may be a more likely diagnosis than MPGN.

Vasculitis

Vasculitis refers to a group of disorders characterized by inflammation of the blood vessels, which can restrict blood flow and damage organs, including the kidneys. Symptoms vary depending on the type of vasculitis and the organs involved.

How to Differentiate Vasculitis from MPGN

Vasculitis and membranoproliferative glomerulonephritis can both cause kidney inflammation, leading to symptoms such as blood in the urine, swelling, and high blood pressure. However, vasculitis often presents with systemic symptoms, including fever, weight loss, fatigue, and skin rashes, which are not typical of MPGN.

Blood tests for vasculitis may reveal elevated inflammatory markers, such as ESR (erythrocyte sedimentation rate) or CRP (C-reactive protein), as well as specific antibodies like ANCA (anti-neutrophil cytoplasmic antibodies). A kidney biopsy can identify inflammation patterns characteristic of vasculitis, which differ from those seen in MPGN. If you experience systemic symptoms and signs of inflammation in multiple organs, vasculitis may be more likely than MPGN.

Diabetic Nephropathy

Diabetic nephropathy is kidney damage caused by long-term diabetes, leading to protein in the urine, high blood pressure, and eventually reduced kidney function. It is a common complication of poorly controlled diabetes.

How to Differentiate Diabetic Nephropathy from MPGN

Both diabetic nephropathy and membranoproliferative glomerulonephritis can cause protein in the urine and kidney dysfunction. However, diabetic nephropathy typically develops gradually in individuals with a long history of diabetes and is often accompanied by other diabetes-related complications, such as retinopathy (eye damage) or neuropathy (nerve damage).

Blood sugar tests and hemoglobin A1c levels can confirm diabetes as the underlying cause. A kidney biopsy may reveal changes specific to diabetic nephropathy, such as thickening of the glomerular basement membrane, which are not seen in MPGN. If you have diabetes and related complications, diabetic nephropathy is more likely than MPGN.

Hypertension

Hypertension, or high blood pressure, occurs when the force of blood against artery walls is consistently too high. Over time, uncontrolled hypertension can damage blood vessels and organs, including the kidneys.

How to Differentiate Hypertension from MPGN

Hypertension and membranoproliferative glomerulonephritis can both cause high blood pressure and kidney damage. However, hypertension is often asymptomatic in its early stages and may only be detected during routine blood pressure checks. In contrast, MPGN frequently presents with additional symptoms, such as blood in the urine or swelling.

Blood pressure readings are essential for diagnosing hypertension. Imaging studies or blood tests may reveal kidney damage in advanced hypertension, but these findings are generally less specific than those seen in MPGN. If high blood pressure is your primary symptom without other signs of kidney inflammation, hypertension may be the more likely diagnosis.

Treatment Options for Glomerulonephritis

Medications for Glomerulonephritis Treatment

Corticosteroids

Corticosteroids are commonly prescribed to reduce inflammation by suppressing the immune system, making them particularly effective for autoimmune-related glomerulonephritis, such as membranoproliferative glomerulonephritis (MPGN). These medications are often the first-line treatment for moderate to severe MPGN, especially in conditions like lupus nephritis or IgA nephropathy. While corticosteroids can improve kidney function and decrease inflammation over weeks to months, long-term use requires careful monitoring for potential side effects, including weight gain and elevated blood sugar levels.

Immunosuppressants

Immunosuppressants, such as cyclophosphamide, mycophenolate mofetil, and tacrolimus, work by inhibiting the immune system to prevent further kidney damage. These medications are typically used in severe cases or when corticosteroids alone are insufficient. They are particularly beneficial for autoimmune-related glomerulonephritis or rapidly progressive forms like MPGN. With consistent use, patients may experience gradual improvements in kidney function and a reduction in proteinuria (protein in the urine) over several months.

Angiotensin-Converting Enzyme (ACE) Inhibitors

ACE inhibitors are prescribed to lower blood pressure and reduce protein leakage in the urine, a common symptom of MPGN. These medications are especially helpful for patients with high blood pressure or significant proteinuria and are a cornerstone of chronic kidney disease management. Patients often notice improved blood pressure control and reduced proteinuria within weeks, which helps slow the progression of kidney damage.

Diuretics

Diuretics, often referred to as “water pills,” assist the kidneys in removing excess fluid and salt, which helps reduce swelling and lower blood pressure. These medications are commonly used for patients experiencing edema (swelling) or high blood pressure due to fluid retention. When combined with ACE inhibitors, diuretics can provide noticeable relief from swelling and improved blood pressure control within days to weeks.

Antihypertensives

Antihypertensive medications, including beta-blockers, calcium channel blockers, and ARBs (angiotensin II receptor blockers), are used to manage high blood pressure, a frequent complication of glomerulonephritis. By maintaining healthy blood pressure levels, these medications reduce strain on the kidneys and are often used alongside other treatments for MPGN. Patients typically experience improved blood pressure control within a few weeks, which helps protect kidney function over time.

Statins

Statins are prescribed to lower cholesterol levels, which can help prevent blood vessel damage and slow the progression of kidney disease. These medications are particularly beneficial for patients with glomerulonephritis and high cholesterol as part of a broader strategy to reduce cardiovascular risks associated with chronic kidney disease. Patients often see a reduction in cholesterol levels within weeks of starting treatment.

Erythropoietin

Erythropoietin (EPO) is a hormone that stimulates the production of red blood cells. Synthetic EPO is used to treat anemia, a common complication of chronic kidney disease and advanced glomerulonephritis. Administered via injection, EPO is typically reserved for patients with significant anemia caused by MPGN or other chronic forms of glomerulonephritis. Many patients report increased energy levels and reduced fatigue within weeks of starting treatment.

Plasmapheresis

Plasmapheresis is a procedure that removes harmful antibodies from the blood and is used in severe cases of autoimmune-related glomerulonephritis, such as Goodpasture syndrome or ANCA-associated vasculitis. This treatment is typically reserved for rapidly progressive or life-threatening immune-mediated kidney diseases, including MPGN, and is often combined with immunosuppressants. Patients may experience symptom relief and stabilized kidney function within days to weeks, though multiple sessions are often required.

Antibiotics

Antibiotics are used to treat bacterial infections that can trigger glomerulonephritis, such as post-streptococcal glomerulonephritis. These medications are prescribed when a bacterial infection is identified as the underlying cause of kidney inflammation. Patients can expect the infection to resolve within days, leading to reduced kidney inflammation and preventing further damage.

Vitamin D Supplements

Vitamin D supplements are essential for supporting bone health and regulating calcium levels, particularly in patients with chronic kidney disease and low vitamin D levels. These supplements are often recommended for advanced glomerulonephritis to prevent complications such as osteoporosis. Consistent use over several months can improve bone health and reduce the risk of fractures.

Procedures for Advanced Glomerulonephritis

While medications form the foundation of glomerulonephritis treatment, certain procedures play a critical role in diagnosis and management. A kidney biopsy is often necessary to confirm the diagnosis and guide treatment decisions. For patients with end-stage kidney disease resulting from severe or untreated glomerulonephritis, options like dialysis or kidney transplantation may be required.

Improving Glomerulonephritis and Seeking Medical Help

In addition to medical treatments, lifestyle changes can play a significant role in managing glomerulonephritis. Consider incorporating these strategies into your daily routine:

1. Reduce salt intake: Lowering sodium helps control blood pressure and reduce swelling.
2. Stay hydrated: Drinking adequate water supports overall kidney function.
3. Maintain a healthy weight: Managing your weight reduces strain on the kidneys.
4. Avoid processed foods: These often contain high levels of sodium and unhealthy fats.
5. Manage blood pressure: Regular monitoring and adherence to prescribed antihypertensive medications are crucial.
6. Limit alcohol consumption: Reducing alcohol intake promotes kidney health.
7. Quit smoking: Smoking accelerates kidney damage and increases cardiovascular risks.
8. Eat a balanced diet: Focus on nutrient-rich foods like fruits, vegetables, lean proteins, and whole grains.
9. Monitor protein intake: Consuming excessive protein can strain the kidneys, so moderation is key.
10. Practice stress management: Techniques such as meditation or yoga can help lower blood pressure.

If symptoms worsen—such as increased swelling, fatigue, or changes in urine output—seek medical attention promptly. Telemedicine offers a convenient way to consult nephrology specialists from the comfort of your home, ensuring timely care and intervention.

Living with Glomerulonephritis: Tips for Better Quality of Life

Living with glomerulonephritis, including membranoproliferative glomerulonephritis, can be challenging, but taking a proactive approach can significantly enhance your quality of life. Adhere to your treatment plan, attend regular medical check-ups, and monitor your symptoms closely. Incorporate light physical activity to maintain overall health, and seek emotional support from friends, family, or support groups. Telemedicine can be an invaluable resource, allowing you to consult nephrology specialists and primary care providers without the need for travel.

Conclusion

Glomerulonephritis is a complex condition that can significantly impact kidney function and lead to serious complications if left untreated. Early diagnosis and prompt treatment are essential for slowing disease progression and improving outcomes. By working closely with your healthcare provider and making necessary lifestyle changes, you can effectively manage your condition and maintain a better quality of life.

If you are experiencing symptoms of glomerulonephritis or have concerns about your kidney health, our telemedicine practice is here to help. Schedule a virtual consultation today to receive personalized care and guidance from the comfort of your home.

James Kingsley

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