Glomerulonephritis: Causes, Symptoms, Diagnosis & Treatments

1. Overview

The inflammation of glomeruli is called Glomerulonephritis. Glomeruli filter waste from blood. Glomerulonephritis happens due to an infection or immune disorder, which can lead to renal failure if not treated on time. 

Glomerulonephritis has two types depending on progression severity and stage: 
1.  Acute
2.  Chronic
Glomerulonephritis is inflammation of the glomeruli, which are responsible for filtering blood and wastes in the kidneys. An infection or immune system disorder usually causes it, resulting in renal failure if not treated timely. Glomerulonephritis is of two types, acute and chronic, depending on the severity of the disease, from mild to severe. 

Acute glomerulonephritis can occur suddenly due to any infection or immune reaction. Chronic glomerulonephritis takes time and develops slowly, from months to years. It progresses over time, and without proper treatment, it causes chronic kidney disease or chronic renal failure.

According to Medscape, 25–30% of all cases of end-stage renal disease (ESRD) are caused by glomerulonephritis (GN). It leads to renal impairment and chronic kidney disease (CKD). In the U.S., GN is the third prevalent cause of ESRD after diabetes and hypertension.

Nephrons are functional units of kidneys, and each kidney contains millions of nephrons. The glomerulus is the major filtering unit of the kidney, which is formed by a network of small capillaries. These are covered in a cup-shaped structure known as Bowmann’s capsule, and each glomerulus is located at the beginning of nephrons. 

The glomerulus is a filtering unit and is made with a bundle of capillaries. The blood flows into the nephrons through the afferent arteriole into the glomeruli. The glomerulus walls allow smaller molecules, including waste and fluid, to pass into the tubule (the structure of the nephron). They do not allow larger molecules, like proteins and blood cells, to pass, so they stay in the blood vessels.

The glomerular filtration filters excess fluid and waste products from the blood and produces urine, which the body then eliminates. Every minute, the kidneys and urinary system receive a litre of blood, which forms about 1.5 litres of urine per day. Excess water, metabolic waste products, and electrolytes are excreted in the form of liquid, i.e., urine.

According to the National Kidney Foundation, the normal glomerular filtration rate (GFR) is 90-120 mL/min/1.73 m2, and it decreases with age. GFR values lower than 60 indicate a kidney problem, and renal failure occurs when the GFR value decreases to 15 mL/min/1.73 m2.

Multiple reasons, including toxins, infection, or autoimmune conditions, cause the inflammation (swelling) of glomeruli, damaging the filtering parts of the kidneys. It disrupts the normal functioning of kidneys and decreases renal blood flow and GFR values. It loses the ability to filter blood and remove waste products from the blood, which results in the excessive buildup of waste in the body

Glomerulonephritis results in reduced kidney functioning and can lead to acute kidney injury (AKI). It also causes blood clotting, increased blood pressure, and hypercholesterolemia. If treated on time, it is reversible and treatable. If left untreated, glomerulonephritis causes CKD, or renal failure. Glomerulonephritis is reported to be twice as common in males than in females, particularly in IgA nephropathy. However, the prevalence may vary across different types of GN

The Australian Institute of Health and Welfare (AIHW) highlighted the prevalence of glomerulonephritis in Australia. In 2021, glomerulonephritis caused about 17% of all new kidney failure cases. The NIH also highlighted that glomerulonephritis contributes to 10-15% of end-stage renal disease (ESRD) cases in the U.S.

2. Types of Glomerulonephritis

Glomerulonephritis is of two types, primary and secondary, depending on the cause. Primary glomerulonephritis directly affects the kidneys due to known reasons, while secondary glomerulonephritis results in damaged kidneys due to other health conditions like cancer, infection, or autoimmune disease.

Primary and secondary types of glomerulonephritis require proper treatment with medicines. If left untreated, both result in acute and chronic kidney disease (CKD) and renal failure.

Classification of GN Types

1. Primary GN Types

Primary glomerulonephritis is further classified into the following types:.

Immunoglobulin A (IgA) Nephropathy: 

IgA nephropathy, also known as Berger’s nephropathy, is the most common type of glomerulonephritis in adults worldwide. It results when the germ-fighting protein 'immunoglobulin A’ builds up in the kidneys and causes swelling over time. 

IgA nephropathy damages kidney cells and makes it difficult to filter waste products from the blood. It is treatable, but the prognosis shows that 20% of cases lead to end-stage renal failure (ESRD). 

In normal functioning of kidneys, the glomeruli filter blood to separate waste and excess water in the form of urine. In IgA nephropathy, it prevents the filtering process that causes leakage of blood and protein to appear in the urine. If the urine contains 3-3.5 g of protein daily, it shows nephrotic range proteinuria.

High values of IgA indicate infection or chronic inflammation. The normal range of IgA for a healthy adult is 80–350 mg/dL. The values above 400 mg/dL show chronic inflammation. To diagnose IgA nephropathy, blood tests, urine tests, kidney biopsy, and iothalamate clearances are beneficial. 

Doctors usually recommend ACE inhibitors for the treatment of IgA nephropathy. Doctors mostly observe higher IgA levels in diseases such as autoimmune, pulmonary, liver, gastrointestinal inflammatory, and plasma cell disorders, although these levels are nonspecific. Up to 1% of people suffer from partial or total IgA deficiency, which is usually asymptomatic.

Focal Segmental Glomerulosclerosis (FSGS): 

Focal segmental glomerulosclerosis is a disease that causes scars on glomeruli tissues. In FSGS, specific foci of glomeruli within the kidneys are affected, resulting in damage to only a segment of each glomerulus of each individual. It is a severe condition, and about 50% of the people with FSGS face a gradual worsening of their kidney function, which leads to kidney failure. Proteinuria, edoema, and fluctuation in blood pressure are some common symptoms of FSGS, and proper treatment requires dialysis or transplant. FSGS can be of the following types:

• Primary FSGS: People who are diagnosed with primary focal segmental glomerulosclerosis have no known cause, i.e., idiopathic. 
• Secondary FSGS: Several factors, such as infection, drug toxicity, or diseases like diabetes or obesity, can cause secondary FSGS.
• Genetic FSGS: This is a rare type of FSGS caused by genetic changes, also known as familial FSGS. It occurs if neither parent has the disease, but both carry a changed gene that they can pass down to their children.
• Unknown FSGS: In rare cases, the cause of FSGS cannot be determined after the complete assessment of clinical symptoms and testing. 

Minimal Change Glomerulonephritis (MCD)

Minimal change disease is the common cause of idiopathic nephrotic syndrome, which damages the glomeruli. The damage is not visible under the regular microscope but only seen with an electron microscope, so it is named minimal change glomerulonephritis.

MCD is more common in children; it accounts for 70–90% of nephrotic syndrome.

It affects kidney filters and causes foamy urine that results in swelling. Proteinuria (protein in the urine), oedema (swelling of body parts), and weight gain are some common symptoms of MCD.

Doctors prescribe corticosteroids (steroids) to treat its complications in children.

The other method of treatment is cytotoxic therapy, and doctors prescribe an ACE inhibitor or ARB when steroids show no effect. They usually do not recommend cytotoxic therapy (cyclosporin) due to its side effects.

Some types of allergic reactions, overuse of NSAIDs, tumours, or infections can cause minimal change disease (MSD).

2. Secondary GN Types

Secondary glomerulonephritis is a broad term that covers various glomerular diseases that result from an identifiable underlying or systemic cause, such as infection, autoimmune disease, or some medicines.

Lupus Nephritis: 

Lupus nephritis is an autoimmune disorder in which the body’s immune system attacks its cells. Systemic lupus erythematosus (SLE or lupus) commonly causes kidney damage, which worsens over time and leads to kidney failure.

The NIH showed that the severity of lupus nephritis ranges from mild to severe and is more common in women during their childbearing years than in men.  Hispanic people, Black people, and Asian Americans are more prone to getting lupus nephritis than whites.

Lupus nephritis affects about 30–50% of systemic lupus erythematosus (SLE) patients, which results in kidney damage.

Changes in urine colour, foamy urine, hematuria, proteinuria, oedema, and increased blood pressure are some common signs of lupus nephritis. 

Goodpasture Syndrome

Goodpasture syndrome is a very rare but life-threatening autoimmune disease in which the immune system attacks tissues of the lungs and kidneys. The common symptoms of Goodpasture syndrome are trouble breathing, fatigue, chest pain, and coughing with blood.

Early diagnosis helps in the treatment of the disease, but if left untreated, it damages the lungs and causes kidney failure and even death. 

The survival rate of Goodpasture syndrome depends on early treatment with plasmapheresis (plasma exchange) and immunosuppressive drugs (such as corticosteroids).

The National Kidney Foundation highlighted a 5-year survival rate of 80% for people with Goodpasture syndrome, and the mortality rate is 90% due to renal or lung failure. 

Granulomatosis with Polyangiitis (GPA): 

Granulomatosis is a rare form of vasculitis that causes inflammation of blood vessels. It mostly affects the upper respiratory tract, lungs, and kidneys.

It decreases the blood flow of some organs, and affected tissues develop areas of inflammation called granulomas. 

Early diagnosis and treatment of granulomatosis are fully recoverable. If left untreated, it can cause complications and renal failure.

The exact cause of GPA is unknown, but it affects adults between the ages of 40 and 65. The symptoms that indicate granulomatosis with polyangiitis are hematuria, fever, fatigue, shortness of breath, joint pain, numbness in fingers and toes, blood in urine, weight loss, skin soreness, and redness in the eyes and ears.

GPA is treated with corticosteroids, rituximab, cyclophosphamide, antibiotics, and plasmapheresis. A biopsy is the only way to confirm the diagnosis of granulomatosis with polyangiitis.

Henoch-Schonlein Purpura (HSP): 

Henoch-Schonlein Purpura (HSP) results are due to the inflammation and bleeding of small blood vessels in the skin, joints, intestines, and kidneys. 

It causes reddish-purple rashes (also known as purpura) on the skin, more commonly seen on the lower legs and buttocks due to bleeding on the skin. This rash usually disappears in a week, but sometimes it lasts as long as one month. 

Henoch-Schonlein purpura is more common in children under age 10 but can affect anyone. It causes abdominal pain and aching joints. Rash, swollen joints, nausea, vomiting, bloody stools, and proteinuria are some visible symptoms of Henoch-Schonlein-Purpura disease.

In rare cases, HSP progresses to hemorrhagia (blood in the urine), which can lead to impaired kidney function and result in kidney failure. Henoch-Schonlein purpura is more common in males than in females. 

Polyarteritis Nodosa (PAN)

Polyarteritis nodosa (PAN), also known as ‘panarteritis nodosa,’ is an autoimmune disease causing inflammation of medium-sized blood vessels (vasculitis) that causes injuries to specific organs, especially kidneys. 

Inflammation results in aneurysms (weak parts of an artery), blood clotting, gangrene, rupturing, and bleeding of tissues and damages organs by decreasing oxygen supply and nutrients. 

The exact cause of Polyarteritis Nodosa is unknown, but hepatitis B (and sometimes hepatitis C) infection may contribute to PAN.

It is a rare condition that affects fewer than 10 people per year. Although it can affect people of all ages, it is most commonly seen in people between the ages of 45 and 65.

PAN also affects joints, nerves, the intestinal tract, skin, and muscles and shows visible symptoms such as muscle weakness, joint aches, fatigue, bloody stool, abdominal pain, loss of appetite, weight loss, shortness of breath, increased blood pressure, and renal failure.

Doctors diagnose PAN through blood tests, urine tests, X-ray MRA scans, CT scans, and biopsies. They commonly treat it with immunosuppressive medicines like cyclophosphamide and corticosteroids to eliminate inflammation.

3. Acute GN Types

Acute glomerulonephritis is a sudden-onset disease often caused by infection and results in hematuria, proteinuria, and leakage of RBC in the urine. It is important to treat acute GN on time to prevent further complications and renal failure. 

Acute Proliferative Glomerulonephritis

Acute proliferative glomerulonephritis, also known as postinfectious glomerulonephritis (PIGN) or post-streptococcal glomerulonephritis (PSGN), often follows an infection and rapidly inflames the glomeruli. Bacterial infections, particularly Streptococcus bacteria, usually cause this disease of small blood vessels. It links kidney disease with lymphoma and carcinomas.

The symptoms of acute proliferative glomerulonephritis include swelling, hematuria, oliguria, increased blood pressure, and decreased urinary output. 

The disease is not contagious and self-limited but still requires treatment. If left untreated, it leads to chronic glomerulonephritis.  Treatment of acute proliferative glomerulonephritis involves managing symptoms and other diseases, like increased blood pressure. Doctors recommend corticosteroids (steroids) for the treatment of acute proliferative glomerulonephritis.

Rapidly Progressive Glomerulonephritis (RPGN)

Rapid progressive is another type of acute glomerulonephritis in which there is a rapid decrease in kidney functioning. It results in microscopic glomerular crescent formation that causes renal failure within weeks to months. The cause of RGPN is idiopathic, but half of the cases are linked with underlying diseases such as Goodpasture syndrome, systemic lupus, or granulomatosis with polyangiitis. Weakness, fatigue, anorexia, abdominal pain, hemorrhagia, and proteinuria are some noticeable symptoms of rapidly progressive glomerulonephritis (RPGN). It results in increased creatinine levels and lower hemocrit readings in renal functioning tests (RFT).

RGPN requires quick intervention to prevent renal failure. Urinalysis, serologic tests, and renal biopsy easily diagnose it. Doctors give an IV dose of methylprednisolone along with oral prednisone to treat RGPN. They also prescribe other medications, such as corticosteroids, cyclophosphamide or rituximab, and plasmapheresis.

4. Types of Chronic Glomerulonephritis 

Chronic glomerulonephritis is a slowly progressive loss of kidney functions over time. The kidney damage does not occur suddenly but takes years to develop. It is mainly caused by other underlying conditions such as genetic factors, immune system diseases, and chronic infections. Chronic glomerulonephritis includes the following types:.

Membranoproliferative Glomerulonephritis (MPGN)

MGPN is a chronic condition caused by the thickening of the glomerular basement membrane. It is caused by an abnormal immune system response. In MGPN, the immune system attacks healthy cells and damages glomeruli. It is common in children and young adults. 

 It is a chronic condition that requires immediate treatment. Hematuria, proteinuria, oedema, and increased blood pressure are common symptoms of membranoproliferative glomerulonephritis. MGPN is diagnosed through urine tests, blood tests, eGFR values, and kidney biopsy. It is treated with immunosuppressive drugs, corticosteroids, and ACE inhibitors.  The negligence of symptoms and ignoring treatment options lead to chronic kidney disease or renal failure.

Alport Syndrome:

Alport syndrome is a rare genetic disorder characterised by kidney disease. It is caused by abnormalities in the gene mutation of type 4 collagen protein. The common symptom of Alport syndrome is the presence of blood and protein in the urine. It causes deafness and vision loss, with a gradual loss of kidney function and results in ESRD.

Doctors confirm the diagnosis of Alport syndrome through eGFR, genetic testing, hearing tests, and kidney biopsies. While Alport syndrome is not yet treatable, they prescribe medicines such as ACE inhibitors, ARBs, and recommend a controlled diet to slow the progression of renal failure.

Analgesic Nephropathy

Analgesic nephropathy is a chronic tubulointerstitial nephritis that is linked to long-term overuse of painkillers. Analgesics damage the small blood vessels of the glomerulus that are responsible for filtration. The overuse of painkillers, including acetaminophen, aspirin, and NSAIDs, is harmful. The combination of analgesics containing phenacetin (aspirin, acetaminophen, codeine, or caffeine) causes nephropathy. 

Nonsteroidal anti-inflammatory drugs (NSAIDs) are a class of analgesics  that are helpful to manage pain and associated inflammation. Long-term and overuse of NSAIDs are linked with a higher risk of AKI and Glomerulonephritis. 

Some people do not show any symptoms of analgesic nephropathy. The common symptoms include fatigue, hematuria, decreased urine output, nausea, vomiting, and numbness in arms and legs. Doctors diagnose analgesic nephropathy by monitoring blood pressure, conducting urine toxicology screenings, performing urinalysis and CBC, and taking an intravenous pyelogram (X-ray of the kidneys, ureters, and bladder). They typically treat the symptoms by stopping painkillers, improving the patient's diet, and providing behavioral counseling.

3. Causes of Glomerulonephritis 

Glomerunephritis are caused by 

• Bacterial and viral infection
• Vasculitis
• Lupus inflammation
• Immune Disorders
• Genetic conditions
• Chronic kidney disease
• Cancer
• Overuse of drugs

Infections

Bacteria or viral infections can lead to glomerulonephritis. The infections that can cause glomerulonephritis include

• Post-streptococcal glomerulonephritis: Post-streptococcal glomerulonephritis is caused by streptococcal bacteria. It usually results after two weeks of recovery from a strep throat infection or a skin infection. The bacteria stays in the glomeruli and causes disease. Children are more prone to suffer post-streptococcal glomerulonephritis than younger people. 

• Bacterial Endocarditis: Bacterial endocarditis refers to an infection affecting the inner lining of the heart's chambers and valves. The inflammation observed in the kidneys is not confirmed to be due to immune system activity or if other factors are involved.

• Viral Infection: Viral kidney infections, including those caused by hepatitis B and hepatitis C, result in inflammation of the glomeruli and other kidney tissues.

• HIV: is the virus responsible for AIDS and can also lead to glomerulonephritis. It gradually damages kidney tissue, potentially occurring even before AIDS develops.

Vasculitis

Vasculitis refers to the inflammation of blood vessels. Several types of vasculitis can lead to glomerulonephritis, including: 

 

• Polyarteritis Nodosa: This type of vasculitis affects medium and small blood vessels throughout the body, such as the kidneys, skin, muscles, joints, and digestive system.
• Granulomatosis with Polyangiitis: Previously known as Wegener's Granulomatosis, this form of vasculitis affects small and medium blood vessels in the lungs, upper airways, and kidneys.

• Other forms of Vasculitis: Other forms of vasculitis involve  microscopic polyangitis and eosinophilic granulomatosis with polyangiitis (also known as Churg-Strauss). Microscopic polyangitis refers to the inflammation of small blood vessels, and Churg-Strauss refers to the inflammation and increased levels of eosinophils (a type of WBC) that damage glomeruli and cause Glomerulonephritis.  

Autoimmune diseases

Autoimmune diseases are conditions where the immune system mistakenly attacks healthy tissues of the body. Some autoimmune diseases that can lead to glomerulonephritis include

• Systemic Lupus Erythematosus (SLE): This chronic inflammatory disease, also known as systemic lupus erythematosus, can affect various parts of the body, such as the skin, joints, kidneys, blood cells, heart, and lungs.
• Goodpasture’s syndrome: A rare condition in which the immune system produces antibodies that target tissues in the lungs and kidneys and cause progressive and chronic kidney damage.
• IgA nephropathy: Immunoglobulin A (IgA) is an antibody that serves as a primary defence against infections. IgA nephropathy occurs when IgA deposits build up in the glomeruli, leading to inflammation and damage that may go unnoticed for a longer time. The most common symptom is the presence of blood in the urine.
• Membranoproliferative Glomerulonephritis: Membranoproliferative glomerulonephritis causes the thickening of the glomerular basement membrane.
• Nephrotic Syndrome: Nephrotic syndrome is a condition in which the kidneys are unable to filter blood, and protein leaks from the blood and appears in the urine. 
• Amyloidosis: Amyloidosis happens when the immune system produces abnormal proteins known as amyloid. These proteins build up in different tissues and organs, such as the kidneys, resulting in glomerulonephritis.

Sclerotic conditions

Certain conditions cause scarring of the glomeruli, which in turn results in decreased kidney function. These include:

• High blood pressure. If high blood pressure is poorly managed over a long period, it can lead to scarring and inflammation of the glomeruli. Glomerulonephritis decreases the kidneys' ability to filter blood and regulate blood pressure.
• Diabetic kidney disease (diabetic nephropathy).  Increased blood sugar levels also cause scarring of the glomeruli and increased blood flow through the nephrons, damaging kidney tissues.
• Focal segmental glomerulosclerosis. This condition involves scarring in some of the glomeruli. It may arise from another underlying disease or occur without any known cause.

Other Causes: 

Other causes of glomerulonephritis involve genetic conditions, medication-induced nephropathy, cancer-related syndromes, and end-stage kidney disease.

Genetic Conditions: 

Some types of glomerulonephritis are linked with genetic disorders that affect the kidneys' structure and function.

• Alport syndrome is a genetic disease caused by an abnormality in the gene mutation of type 4 collagen protein. It causes progressive kidney damage, hearing loss, and eye problems. 

Chronic Kidney Disease:

Long-term kidney damage from other health diseases also leads to glomerulonephritis. It includes

• Analgesic Nephropathy: Excessive use of painkillers, especially with combinations like aspirin and acetaminophen, can cause chronic kidney damage. This condition causes scarring in the glomeruli and may contribute to glomerulonephritis.
• NSAID-Induced Nephropathy: Overusing nonsteroidal anti-inflammatory drugs (NSAIDs) decreases blood flow to the kidneys. It leads to inflammation of the glomeruli and renal damage that contributes to glomerulonephritis.

Cancer

Certain cancers can cause abnormal immune responses, which damage kidney cells and cause glomerulonephritis. Some cancers related to glomerulonephritis include gastric cancer, lung cancer, and chronic lymphocytic leukaemia.

• Paraneoplastic Syndromes: This is a rare disorder that occurs when the immune system targets the kidneys in response to cancer, such as lung, breast, or kidney cancer. Due to this effect, this systemic immune response results in glomerulonephritis.

Drugs

Certain drugs, such as classes of analgesics and NSAIDs, lead to analgesic nephropathy.

• Analgesics: Excessive use of painkillers and combination drugs such as aspirin, acetaminophen, or phenacetin can progress to analgesic nephropathy and cause chronic kidney disease. The long-term usage of analgesics damages the filtering units (glomeruli) and results in glomerulonephritis.
• NSAIDs: Some drugs, such as diclofenac, naproxen, and ibuprofen, can cause NSAID-induced nephropathy. Its excessive use inhibits the production of prostaglandin (a hormone required for maintaining the blood flow of kidneys) and leads to reduced kidney functioning, which leads to glomerulonephritis. 

 

4. Symptoms of Glomerulonephritis 

The symptoms of glomerulonephritis depend on the stage of kidney disease, which helps to identify whether it's acute, chronic, or advanced. Each symptom shows a different level of kidney damage and severity of the disease.

1. Acute Symptoms of Glomerulonephritis

These symptoms show acute glomerulonephritis that is caused by the inflammation or sudden response affecting the glomeruli of the kidneys

• Hematuria:

 Blood in the urine is a common symptom of kidney damage. The damage to the glomeruli causes blood leakage in the urine, and the urine appears dark, pink, or light brown.

According to the NIH, about 60–80% of patients with acute glomerulonephritis show hematuria in macroscopic and microscopic urine samples.

• Proteinuria: 

When the glomeruli of the kidneys become damaged, it results in improper blood filtration that causes protein leakage in the urine, termed proteinuria. The high levels of protein in the urine test indicate kidney damage. 

The National Kidney Foundation (NKF) highlighted the normal protein values in excreted urine. Normally, the protein value is less than 150 mg/day.  In acute glomerulonephritis, the protein value increases up to 3.5 g/day, which indicates acute glomerulonephritis.

• Nausea and vomiting:

 In acute glomerulonephritis, the improper functioning of the kidneys results in the buildup of toxins in the blood, which causes nausea and vomiting. This symptom struggles to maintain homeostasis in the body. 

The NIDDK reported uremic toxins, nausea, and vomiting as common symptoms of acute glomerulonephritis.

• Shortness of breath:

 Acute glomerulonephritis often causes shortness of breath due to fluid retention caused by kidney damage. It also causes pulmonary edoema (fluid accumulation in the lungs).

Researchers conducted a prospective observational study on children to evaluate the signs of acute glomerulonephritis, including 66 children. They concluded that pulmonary oedema occurs in about 20–30% of the symptoms.

• Swelling (Oedema): 

Swelling of the legs, face, and hands is another symptom of kidney damage. It is caused by fluid retention and the kidneys' inability to eliminate excess fluid.

According to NIDDK, oedema in acute GN is the most common and noticeable symptom in the lower extremities and around the eyes, indicating kidney damage. 

B. Chronic Symptoms of Glomerulonephritis

The symptoms of chronic glomerulonephritis do not show noticeable symptoms at early stages, but it is long-term and progressive kidney damage that takes years to develop. If the symptoms of acute glomerulonephritis are ignored and left untreated, it leads to chronic conditions. The common symptoms of chronic glomerulonephritis include

• Persistent Proteinuria: 

The continuous loss of protein in the urine decreases kidney health and causes swelling and hypoalbuminemia (low protein levels in the blood).

Long-term proteinuria decreases the overall quality of life of renal patients and also increases the risk of cardiovascular diseases, CVD, and chronic kidney diseases, CKD. 

• Hypertension (High Blood Pressure): 

Chronic glomerulonephritis results in fluid retention, which increases vascular resistance. The damaged kidneys struggle to regulate blood pressure, resulting in raised blood pressure.

• Foamy/Bubbly Urine: 

Foam and bubbles in the urine show the levels of protein in the urine. The formation of bubbles indicates excess protein in excreted urine, which indicates chronic glomerulonephritis. 

• Fatigue and Muscle Cramps: 

Fatigue and muscle cramps are also common symptoms of chronic glomerulonephritis. The fatigue is due to anaemia (lower production of RBC due to kidney damage), and muscle cramps result from an imbalance of electrolytes (low potassium and magnesium levels).

The NIDDK reported that people with chronic glomerulonephritis often experience fatigue and muscle cramps, which decrease their quality of life. 

• Weight Loss and Appetite Changes: 

Unintentional weight loss is another symptom of kidney damage. It is due to appetite loss and metabolic disturbances. Several studies on chronic glomerulonephritis show gradual weight loss with poor kidney functioning.

C. Advanced Symptoms of Glomerulonephritis

As the kidney disease progresses, it shows advanced symptoms, which leads to end-stage renal disease (ESRD) and other complications. It includes

Kidney Failure: 

As kidney damage progresses, it leads to renal failure. Lower urine output, swelling of extremities (hands, ankles, foot), and fatigue indicate renal failure. 

The diagnosis of renal failure can be confirmed through eGFR values, blood urea nitrogen (BUN), and increased serum creatinine values. 

According to NIDDK, about 30-40% of patients with chronic glomerulonephritis progress to end-stage renal disease (ESRD) within the diagnosis of 10-15 years and 20-30% require dialysis or transplant for survival. 

Electrolyte Imbalances: 

The decline of kidney function results in electrolyte imbalances, of which hyperkalaemia (high potassium in the blood) is the most common cause of severe complications, including severe fatigue, an irregular heartbeat, and muscle weakness. 

Congestive Heart Failure:

 Glomerulonephritis is directly linked to heart health due to fluid overload and increased blood pressure. It increases pressure on the heart, which causes congestive heart failure. The NIDDK highlighted that about 25% to 50% of patients with advanced glomerulonephritis develop congestive heart problems due to fluid retention and increased blood pressure.

Pulmonary Oedema:

Severe fluid retention causes pulmonary oedema, an advanced symptom of glomerulonephritis, resulting in shortness of breath, cough, and chest pain. It is an emergency condition and requires immediate treatment. It is usually treated with medicines such as diuretics, oxygen therapy, and sometimes mechanical ventilation.

High Cholesterol: 

GN disrupts normal lipid metabolism, resulting in dyslipidemia and increased levels of cholesterol and triglycerides (TGL). The research on ‘The issue of atherosclerosis in primary glomerulonephritis’ indicates that more than 50% of renal patients experience high cholesterol levels, which increases the cardiovascular risk.

5. Complications of Glomerulonephritis 

Glomerulonephritis affects the glomerulus of nephrons and causes complications. It leads to waste accumulation in the blood, electrolyte imbalances, decreased production of red blood cells, protein loss, and impacts the quality of life. The complications of glomerunephritis includes

Blood Clotting

Glomerulonephritis causes blood clotting in deep vein thrombosis (DVT) and pulmonary embolism (PE). The clotting of blood in DVT mainly occurs in the deep veins of the legs. In pulmonary embolism (PE), these clots travel to the lungs, causing life-threatening conditions.

The findings of research published on NIDDK highlighted that patients with GN are at increased risk of developing blood clots, including DVT and PE. The incidence rate of DVT is 3% to 26%, and for PE it is 1% to 9%, depending on the severity of kidney damage.

Chronic Kidney Disease (CKD)

Chronic kidney disease (CKD) is a long-term inflammation of the glomerulus that can last months to years. If the symptoms of CKD are not treated in a timely manner, it can lead to advanced stages of end-stage renal disease (ESRD). The only treatments for CKD are dialysis and kidney transplants. According to the NIH estimation, the total number of individuals affected by CKD stages 1–5 worldwide is about 843.6 million.

Hypertension and Malignant Hypertension:

Increased blood pressure is another common complication of glomerulonephritis. Damage to the kidney filtering unit results in increased blood pressure. The kidneys play an essential role in regulating blood pressure through fluid balance and the renin-angiotensin system. When the kidneys are unable to perform their functions, hypertension or malignant hypertension results. An increase in blood pressure can cause other health problems, including stroke, heart disease, and renal failure. 

Electrolyte Imbalances:

Electrolyte imbalances occur due to glomerulonephritis. It causes increased potassium (hyperkalaemia) due to improper filtration of blood. Hyperkalaemia is manageable through dietary restriction (diet low in potassium), medicines, and dialysis. 

Congestive Heart Failure

Fluid accumulation due to glomerulonephritis puts a strain on the heart that leads to endocarditis (infection of the inner lining of the heart) and congestive heart failure (CHF). When the kidneys become unable to filter blood, it puts strain on the heart due to increased fluid retention.  The NIH highlighted the relationship of GN with CHF. People with CN are at higher risk of heart failure due to cardiovascular stressors.

Pulmonary Oedema: 

Pulmonary oedema refers to excessive fluid accumulation in the lungs. It occurs due to improper kidney function when the kidneys are unable to filter blood and remove excess fluid. 

The blood enters the lungs and causes complications due to GN. In severe cases, it requires immediate treatment with medicines such as diuretics and requires ventilation support. According to NKF, the mortality rate linked with pulmonary oedema in GN patients is 15–50%, depending on the severity. 

High Cholesterol

Glomerulonephritis also causes increased cholesterol levels in renal patients. This happens due to increased protein excretion through the urine, which stimulates the liver to release more lipoproteins, resulting in hyperlipidaemia. An increased level of cholesterol increases the chance of atherosclerosis, heart attack, and stroke. According to the NIH, cardiovascular diseases (CVD) are one of the leading causes of death in patients with CKD, including glomerulonephritis. About 40-60% of GN patients suffer from hyperlipidaemia due to the severity of nephrotic syndrome.

Kidney Failure:

Kidney Failure is a severe complication of glomerulonephritis. It is irreversible and requires kidney dialysis and transplant procedures for survival. GN passes through the stages of CKD, and doctors refer to the 5th (last) stage as end-stage renal disease (ESRD). According to NIDDK, the 5-year survival rate of renal patients on dialysis is 35–45%, while on transplant, it is 85%–90%.

Nephrotic Syndrome:

Nephrotic syndrome, also known as nephrosis, is a common complication of glomerulonephritis linked to a high level of protein excreted in the urine. It causes low albumin levels in the blood, hypercholesterolaemia, and oedema. The accumulation of fluids results in severe eye swelling, puffiness, and weight gain.Doctors commonly treat it with corticosteroids, immunosuppressants, ACE inhibitors, and diuretics to manage fluid retention and reduce proteinuria and inflammation. In rare cases, nephrotic syndrome also causes a blood clot in a kidney blood vessel. According to the NIH, nephrotic syndrome can affect children and adults of all ages. The case study related to nephrotic syndrome concluded that delay in hyperlipidaemia increases the risk for a child to suffer from other complications like nephrosis.

Damage to Other Organs:

Glomerulonephritis can also cause damage to other organs like the liver, heart, and nervous system. Liver damage is caused by glomerulonephritis, but it is less common. Due to increased blood pressure and cholesterol, glomerulonephritis also increases the risk of cardiovascular diseases such as heart attack and heart failure.

6. Diagnosis of Glomerulonephritis 

Early diagnosis is necessary to treat the complications of glomerulonephritis. The symptoms show the stages of renal failure, but the diagnosis can be confirmed through the following tests.

Urine Analysis: 

Urine analysis helps to identify and assess the concentration ability of kidneys that are not filtering blood properly. It measures kidney filtration rate, and the presence of protein in the urine shows a diagnosis of glomerulonephritis. The presence of red blood cells in the urine shows hematuria. The pH and osmolality of excreted urine also help in the identification of any kidney disease. The pH level of the normal urine is 5.5–7.5 and of proteinuria is >3.5 g/day. The NIH showed that when the values of proteinuria exceed 500 mg/d to 3 g/d, it indicates glomerulonephritis.

Blood Test:

Blood test values such as red blood cell count, excessive protein loss, BUN, and creatinine values confirm the diagnosis of glomerulonephritis. Low RBC count and albumin levels show anaemia. Blood urea nitrogen (BUN) measures the waste removal of kidneys. The normal BUN values are 7 to 20 milligrammes per decilitre and higher than it shows kidney damage. For creatinine, women have lower creatinine than men due to lower muscle mass. The normal values of creatinine for men are 0.7 to 1.3 mg/dL (61.9 to 114.9 µmol/L) and for women are 0.6 to 1.1 mg/dL (53 to 97.2 µmol/L). 

The NIH reported that higher values of proteinuria, BUN, and creatinine levels are directly linked with severe cases of glomerulonephritis.

Immunology Testing:

Immunology testing is another method to confirm the diagnosis of glomerulonephritis. The testing in immunology involves 

Anti-Glomerular Basement Membrane Antibodies: 

Anti-glomerular basement membrane antibodies test helps to identify the autoimmune disease with the presence of anti-GBM antibodies in the blood. Goodpasture syndrome is diagnosed through this test.

Antineutrophil Cytoplasmic Antibodies (ANCA): 

ANCA are autoantibodies that are produced when the immune system mistakenly attacks its own white blood cells. This test helps to identify whether the patient has one or both types of antibodies (autoimmune vasculitis) that are damaging their own immune system. It is helpful to detect vasculitis-related glomerulonephritis such as granulomatosis with polyangiitis.

Antinuclear Antibodies (ANA): 

Antinuclear antibodies are produced by the immune system, which attacks the nucleus of the cell. An ANA test helps to look for the presence of any ANA antibody in the blood. This test is used to diagnose autoimmune disorders like systemic erythematosus (SLE) and lupus-related glomerulonephritis.

Complement Levels (C3 and C4): 

A complement blood test measures the activity levels of proteins in the complement system. It is a group of proteins that work together in the form of sequences to support the immune system. It also helps the body to fight infection and other diseases and also identifies the overall health of the immune system.

The NIH showed the connection between antibodies (anti-GBM, ANCA, ANA) that are specifically linked with glomerulonephritis. Complement levels are also helpful in differentiating immune-related causes. Diagnosis at the proper time helps in early treatment of glomerulonephritis. 

Kidney Biopsy:

Kidney biopsy is a primary diagnostic tool to confirm the diagnosis of glomerulonephritis. Doctors use a surgical method to diagnose and assess the severity of kidney damage. In a biopsy, they extract a small piece of kidney tissue using a special needle for observation under a microscope.

Pathologists observe unusual deposits, scarring, infection, or any other abnormality in the kidney tissue to confirm glomerulonephritis. The NIH reported that the overall accuracy of a kidney biopsy for the confirmation of glomerulonephritis is 76%, and a nondiagnostic biopsy rate is 5.3%. 

Imaging Tests

Imaging tests are a common method to diagnose glomerulonephritis. It includes CT scans, kidney ultrasound, chest X-ray, and intravenous pyelogram. They look for deformity in size and shape and any blockage in the kidney filter.

 

CT scan: A CT scan provides a visual structure of kidneys. It is helpful to identify any irregularity in kidney shape and size due to kidney cysts or kidney stones. 

 

Kidney Ultrasound: It is a non-invasive test and uses high-frequency sound waves that provide images of blood vessels and tissues of the kidney, which helps to identify any abnormality. Acute and chronic glomerulonephritis, nephrotic syndrome, and amyloidosis can easily be diagnosed through ultrasound. 

 

Chest X-ray: A chest X-ray is helpful for the diagnosis of glomerulonephritis in the case if the patient has a breathing problem. The X-ray shows pulmonary congestion with lighter or darker areas.

Intravenous Pyelogram: An intravenous pyelogram (IVP) is an X-ray imaging test that uses contrast dye to examine any abnormality in the size, shape, and structure of the kidneys, ureter, and bladder. It helps to diagnose congenital anomalies of the urinary tract, enlarged prostate, and neoplasms of the kidney.

The NIH shared research that presents a case study of a 13-year-old Sri Lankan boy with visible symptoms of glomerulonephritis, including severe hypertension, and a diagnosis of acute post-streptococcal glomerulonephritis, made with the help of a CT scan.

7. Treatment for Glomerulonephritis 

There are various methods to treat glomerulonephritis, including dietary modifications, medications, and renal replacement therapy, depending on the severity of kidney damage. Early diagnosis of glomerulonephrits helps in the effective treatment. The treatment options for glomerulinephritis are as below:

Dietary Changes:

Dietary changes are necessary to prevent other complications. It includes the following modifications:.

• Low-Salt Diet: A diet low in sodium and limiting water intake helps to manage blood pressure and also reduces fluid retention and prevents swelling.
• Low Cholesterol, Protein, and Potassium Diets: Diet low in potassium, protein, and cholesterol helps to minimise waste accumulation in the body and prevent complications like hyperkalaemia (high potassium in the blood).
• Calcium Supplements & Fluid Intake: Take calcium supplements according to your doctor’s prescription to make bones stronger, and limiting fluid intake helps to maintain electrolyte balances.

The KDIGO guidelines highlighted that improving dietary changes in glomerulonephritis like low sodium, potassium, and protein intake reduces the inflammation, controls blood pressure, and preserves kidney function.

Immunosuppressants:

Immunosuppressants are prescribed in the autoimmune disease of glomerulonephritis, which suppresses the immune system activity to prevent damage to the kidneys. 

 

Cyclophosphamide and mycophenolate mofetil are commonly recommended immunosuppressions to treat glomerulonephritis. Both have different uses and side effects.

Cyclophosphamide is used in an IV method to treat severe lupus nephritis, and mycophenolate mofetil is used as an alternative with a better safety profile and also to treat idiopathic membranous nephropathy.

The success rate of immunosuppresant depends on the type and severity of glomerular disease. In comparison, cyclophosphamide is effective in severe disease of GN, while MMF is preferred for long-term management in lupus nephritis.

The NIH featured its research that the Euro-Lupus Nephritis Trial shows that cyclophosphamide is effective in inducing remission in up to 60–80% of patients, particularly when used with corticosteroids.

Angiotensin-Converting Enzyme (ACE) Inhibitors:

Doctors commonly use ACE inhibitors to treat the complications of glomerulonephritis. They prescribe medicines, including captopril, lisinopril (Zestril), and perindopril (Aceon), to lower the blood pressure in GN patients.

It also reduces the risk of developing CVD or stroke and limits the amount of protein in the urine (proteinuria).

 

The NIH highlighted its research showing the positive effect of ACE inhibitors in treating glomerulonephritis complications with reduced amounts of protein in the urine, preserving kidney function and controlling blood pressure, and providing long-term benefits in CKD.

Angiotensin II Receptor Blockers (ARB):

ARB medicines are similar to ACE inhibitors, which include losartan (cozaar), irbesartan (Avapro), and valsartan (diovan). ARB also plays a role in managing blood pressure in glomerulonephritis patients and ensures their kidney protection.

ACE inhibitors and ARB are considered kidney protection medicines because they keep the glomeruli healthy and lower the urine albumin ratio (uACR).

 

The NKF shared the comparative effectiveness of ACE inhibitors and ARBs. Both medicines work together in a separate way to lower the effect of the angiotensin-2 hormone released by the body.

Ace inhibitors slow down the release of angiotensin hormone, and ARBs block the receptors, which angiotensin-2 hormone narrows the blood vessels. Both medicines keep the blood vessels relaxed and lower the pressure in the kidneys (throughout the body).

Corticosteroids:

Steroids help in reducing swelling and inflammation by suppressing the immune system. Corticosteroids such as prednisone and methylprednisolone are most commonly used.

These medicines lower glomerular inflammation, decrease proteinuria, and slow the progression of kidney damage. 

Doctors use corticosteroids to treat various types of GN, including idiopathic, infection-related, and postinfectious GN. They also recommend it as the first-line treatment for minimal change disease, focal segmental glomerulosclerosis (FSGS), and lupus nephritis.

The dosage of steroids starts from small amounts and decreases when the kidney starts to recover.

The research of NIH highlighted the benefits of corticosteroids in reducing the symptoms of glomerulonephritis, such as decreasing the amount of protein in the urine and preserving kidney functions.

Dialysis:

Dialysis is the main treatment to treat end-stage renal disease when kidneys fail to filter blood. It can be used to treat glomerulonephritis when it causes acute kidney failure, or ESRD.

Dialysis is an artificial method of filtering blood and of two types: hemodynamic dialysis and peritoneal dialysis.

Haemodialysis: In haemodialysis, blood is passed through a dialyser machine, and filtered blood is returned back to the body. It is a continuous process and requires 3 to 4 hours to complete. Haemodialysis is performed three times a week.

Peritoneal Dialysis: In peritoneal dialysis, a doctor inserts a fluid-filled sac into the abdominal cavity through a catheter. This sac absorbs waste products, which the body then removes.

According to NIH, the survival rate of a median 5-year patient on dialysis is 45% with decreased quality of life. 

Diuretics

Diuretics help lower fluid retention and manage high blood pressure. Water pills, also known as diuretics, treat glomerulonephritis by reducing swelling and eliminating excess water and sodium from the body.

Furosemide and hydrochlorothiazide are commonly used diuretics that help in the excretion of water by combining a chloride-binding cotransport system.

The NIH highlighted the effectiveness of diuretics in its research. The research concluded that diuretics play a major role in managing symptoms of GN, such as reducing swelling, controlling blood pressure, and indirectly protecting kidney function.

Plasmapheresis

Plasma is a part of the blood that contains proteins that may inflame the kidneys. Plasmapheresis is a process to treat GN in which doctors obtain plasma from the blood, which contains harmful antibodies, and replace it with fresh plasma. 

It is performed to remove harmful circulating bodies from the blood that progress to severe glomerulonephritis. It is also beneficial in lowering kidney damage.

Doctors use plasmapheresis to treat severe autoimmune glomerulonephritis (GN) cases, such as Goodpasture syndrome, lupus nephritis, and ANCA-Associated Vasculitis (AAV).

The NIH reported that about 80–90% of patients receiving plasmapheresis with immunosuppressive drugs (corticosteroids and cyclophosphamide) experience stability and improved kidney function.

Kidney Transplant:

The kidney transplant method is the best treatment to treat end-stage renal disease (ESRD) caused by glomerulonephritis, but GN can still reoccur after the transplant.

This is because people with GN are at higher risk of infection due to decreased immunity and the intake of lifelong immunosuppressants to prevent organ rejection. 

When the kidneys severely reduce their functions and can no longer filter blood, doctors perform a transplant using a matched donor, either living or deceased. Kidney transplants overall improve quality of life and long-term survival. 

Before the transplant, the patient went through medical evaluation and health conditions for long-term recovery. The surgery is performed under anaesthesia, and the donor can be living or deceased.

Living donors ensure long-lasting survival rates as compared to deceased donors. After the surgical kidney transplant, healthcare professionals closely monitor the patient and administer lifelong immunosuppressants to prevent organ rejection.

According to the NIH, the patient survival rate of one year of kidney transplant is about 95% for both living and deceased donors. For five years, the survival rate of a kidney transplant from a living donor is 85% and from a deceased donor is 75-80%.

8. Prevention of Glomerulonephritis

There is no specific way to prevent glomerulonephritis, but adopting a healthy lifestyle and eating a healthy diet with exercise can prevent its complications.

Managing Weight 

It is important to maintain a healthy body weight to prevent further complications. Obesity links to other diseases, including chronic kidney disease (CKD), cardiovascular disease (CVD), stroke, and heart attack.

BMI is a body mass index that measures body fat based on height and weight. The normal values of BMI are 18.5 to 24.9 kg/m2.

A BMI greater than 25 indicates that the person is overweight or obese. The CDC reported that obesity increases the risk of high blood pressure and diabetes, which are leading causes of developing CKD. 

Balanced Diet

Eating a balanced diet and avoiding processed foods helps with better management of glomerulonephritis disease. Hypertension is manageable by restricting high protein intake and limiting sodium and potassium intake in the diet. Certain meal plans, including the kidney-friendly eating plan and the DASH diet, are beneficial in preventing kidney diseases.

Managing High Blood Pressure

Managing blood pressure reduces the risk of kidney disease and slows down the progression of kidney damage. The normal values of blood pressure are 120/80 mm/Hg.

The regular monitoring and timely medication of increased blood pressure helps in better management of glomerulonephritis. According to NIH, lowering blood pressure leads to an initial decline in eGFR values. 

Managing Diabetes

Diabetes is the leading cause of chronic kidney disease (CKD) and ESRD. People with glomerulonephritis must control their blood sugar levels to prevent complications such as diabetic nephropathy.

According to NKF, diabetic nephropathy affects 20–40% of diabetic patients, which is the leading cause of CKD and ESRD.

Restricting Protein and Potassium Intake

In glomerulonephritis, it is recommended to limit protein and potassium intake to help control blood pressure and fluid retention. The National Institutes of Health (NIH) suggests that kidney patients should consume less than 2000 mg of potassium per day.

For protein, the recommended dietary allowance (RDA) is 0.6-0.8 g/kg of body weight for patients with chronic kidney disease (CKD) who are not on dialysis and 1-1.2 g/kg of body weight for those who are on dialysis.

Kidney patients should consume foods such as apples, grapefruits, cauliflower, broccoli, white rice, white pasta, and berries. Doctors restrict foods like bananas, avocados, raisins, lentils, spinach, oranges, tomatoes, dairy products, nuts, beef, and chicken for those with kidney disease.

• Quit Smoking: Smoking is a risk factor for developing chronic kidney diseases. By quitting, a person can restore their natural kidney functions and slow the progression of CKD.
• Preventing Infections: Consult a doctor in case of any infection, like strep throat. To prevent infection, follow good hygiene practices and safe sex. For example, practicing safe sex and maintaining personal hygiene helps in the prevention and better management of post-infectious GN cases.
• Regular Healthcare Visits: Regular visits to doctors help in the early detection of disease. Scheduling routine check-ups and kidney function tests (RTs) ensures better prevention of glomerulonephritis with timely treatment.

Using Over-the-Counter (OTC) Medications as Directed:

Use Over-the-Counter (OTC) medicines as directed to prevent infection. Do not overuse NSAIDs, as they contribute to GN and cause complications. The NKF reported that the improper use of OTC medicines such as aspirin, naproxen, and ibuprofen is unsafe and can cause kidney damage.

9. Outlook / Prognosis for People with Glomerulonephritis

The prognosis of glomerulonephritis depends on the following factors:

Factors Influencing Prognosis:

The factors of glomerulonephritis depend on the type and severity of the disease.

Type and severity of GN: acute and chronic glomerulonephritis have different outcomes. Acute glomerulonephritis is more likely to recover than chronic glomerulonephritis. 

Acute glomerulonephritis may resolve with treatment, but chronic glomerulonephritis leads to more severe conditions like chronic failure.

According to NIH, the survival rates of acute GN are better than chronic. About 1% of children and 10% of adults with acute glomerulonephritis may go on to develop chronic kidney disease (CKD).

Recovery Rates: 

Acute GN: With early diagnosis and timely treatment, acute glomerulonephritis is fully reversible and results in full recovery. If left untreated, it leads to chornic complications.

Chronic GN: Chronic glomerulonephritis is linked with a higher risk of progression to kidney failure. It requires long-term management of symptoms and complications with medicines. 

The National Kidney Foundation reported that about 20–30% of people with chronic GN develop kidney failure without early intervention.

Long-Term Health Implications:

People with glomerulonephritis, especially in chronic GN, are more at risk of suffering from hypertension and cardiovascular diseases. According to research, about 50% of GN patients face hypertension and CVD during their lives.

Timely diagnosis and proper medicines are helpful to treat complications of GN.

Quality of Life Considerations: 

Chronic GN patients may face fatigue, swelling, and limitations in doing physical activity. Coping strategies involve exercise and physical activities with a kidney-friendly diet and managing stress that help in the better management of GN patients.

Advancements in Treatment:

The advancement in treatment of glomerulonephitis helps in the better management of symptoms and its complications. The advancement involves targeted immune therapies to treat specific types of GN, such as IgA nephropathy. 

The NIH highlighted that modern techniques show noticeable improvements in patient outcomes with a 70% success rate to treat the progression of GN to renal failure.

Mortality Rates: 

Acute glomerulonephritis is reversible and treatable with early intervention and has a low mortality rate as compared to chronic GN. Without intervention, it leads to chronic GN and causes renal failure. Chronic GN is associated with high mortality rates. 

According to the National Institute of Health, end-stage kidney disease (ESKD) is a leading cause of death in people with chronic GN.

Role of Early Detection: 

Early detection of disease helps in the better management of symptoms. Timely diagnosis shows improved outcomes as compared to later diagnosis with other complications. 

Case studies by NIH showed 30–40% higher chances of a positive outcome as compared to later diagnosis in disease progression.

Patient Education and Support: 

Patient education and support are helpful in the management of treating GN. Support groups and counselling discuss the important points that increase knowledge about disease and how to manage its symptoms.

Online and educational materials are also available on the internet to support the condition of patients in treating GN.

Prognostic Models:

Various healthcare providers are using prognostic models to predict the outcome of diseases. They used it to assess the kidney function to estimate the progression and outcome of kidney failure. Studies reported that some models showed an 85–90% accuracy rate in predicting long-term results.

Future Outlook:

Further research is continuing to improve the outlook of glomerulonephritis. Emerging treatments and clinic trials show improved outcomes to treat chronic types of GN such as IgA nephropathy and gene therapy and immunomodulation.

10. Living With Glomerulonephritis

Living with glomerulonephritis is not easy. The patient may face severe fatigue, swelling, and other symptoms. Still, it is possible to manage the symptoms and complications by following ways.

Managing Glomerulonephritis:

• Medication Adherence: The patient with GN is required to take their prescribed medicines on time to decrease the progression of kidney damage.
• Lifestyle Changes: Lifestyle modification is another important factor to manage glomerulonephritis. Eating a healthy diet with kidney-friendly food, exercise, and avoiding nephrotoxins (such as NSAIDs) is helpful to treat GN symptoms.

By following these instructions, a renal patient can live a normal, healthy life with daily routine adjustments for the management of GN.

Seriousness of GN: 

Glomerulonephritis is a serious disease that causes renal impairment. The NIH stated that the GN leads to 10-15% cases of ESRD in the U.S.

It progresses to CKD and even renal failure without timely intervention.

When to See a Healthcare Provider:

If the patient's glomerulonephritis symptoms worsen, they should consult a healthcare provider for a better assessment of the disease. These are symptoms that require medical attention.

Signs and Symptoms: 

• Frequent blood in the urine
• Joint pain
• Changes in urine colour
• Swelling of legs 
• Puffiness of eyes
• Shortness of breath

If someone experience any of the above symptoms, immediately consult a nephrologist.

Questions to Ask Healthcare Providers:

These are some questions a patient should ask their doctors for a better understanding of disease.

• Am I at higher risk of glomerulonephritis?
• What are my treatment options?
• What can I do to prevent the complications of glomerulonephritis from getting worse?
• Which tests are required to confirm the type of glomerulonephritis?
• How can I manage the symptoms of glomerulonephritis?
• Do you recommend any changes in my diet or medicines?

Emotional and Psychological Support:

Emotional and psychological support, including coping mechanisms (avoiding stress), counselling, and support groups, provides motivation to deal with complications of glomerulonephritis.

These support groups ensure better outcomes and management of symptoms for the fastest recovery of the disease. 

The NIH highlighted the positive effects of support groups in the management of disease. They reported that there is a diret positive association between social support and medical adherence.

Monitoring Health at Home:

Patients can monitor their health at home by checking blood pressure on a daily basis and observing urine output. It helps in early diagnosis and management of the complications of kidney disease. 

Home monitoring devices such as home test kits and wearable sensors help to monitor the kidney health at home. A dipstick urine test measures the albumin level to observe the kidney functioning.

Diet and Nutrition:

Doctors advise renal patients to choose a healthy diet and kidney-friendly foods such as brown rice, oats, and whole grains. Diet low in salt and potassium helps in management of blood pressure and control oedema.

The National Heart, Lung, and Blood Institute (NHLBI) recommends the DASH diet (variety of fruits and vegetables, whole grains, and low-fat dairy items), which is best for renal patients and reduces the risk of kidney diseases. 

Exercise and Physical Activity:

Light-moderate exercise is beneficial for GN patients to keep them healthy and active. It helps to control blood pressure and improves heart function and blood sugar levels.

So, it is advised to start exercising slowly to maintain body weight. According to NKF, the safe exercises for GN patients are walking, hiking, biking, community activities, and doing household chores.

Managing Medications and Treatments:

It is important for GN patients to take their medicines on time. Follow the proper schedule of the exact dose as prescribed by the doctor.

Patients are advised to remember which medicines they need to take on an empty stomach, before meals, or after meals.  They can also use pill organisers and set reminders to ensure timely medicines.

Accessing Resources:

GN patients can find reliable information to manage their condition from the National Kidney Foundation (NKF) and the American Association of Kidney Patients (AAKP).

These websites provide authentic and relevant information about glomerulonephritis, treatment options, and lifestyle modifications. They also provide educational materials, brochures, and articles on GN and kidney health.

Patient advocacy groups such as KDIGO provide guidelines and management for glomerulonephritis patients.

Cleveland Clinic, Mayo Clinic, and NIH are some examples of accessing reliable sources.