Glomerulonephritis

Overview

Glomerulonephritis (say: glom-uh-roo-loh-nef-rye-tis) is a condition where the tiny filters inside your kidneys become inflamed. These filters are called glomeruli. Each kidney has about a million of them, and they work like very fine sieves. They clean your blood by letting waste and extra water pass into your urine while keeping blood cells and protein inside your body. When the filters get inflamed, they can leak blood and protein into your urine, and they may stop cleaning your blood as well as they should. Glomerulonephritis is not one single disease. It is a group of conditions that can be short-term (coming on quickly and often getting better) or long-term (developing slowly over months or years).

Glomerulonephritis is uncommon. Some types are rare. Because mild cases often cause no obvious symptoms, doctors think a number of people have it without knowing, and it is sometimes found by chance on a routine urine test.

It can affect people of any age. Some types are most often seen in children and young adults, usually a few weeks after a throat or skin infection. Other types are more common in adults, especially people who already have a condition such as lupus (where the immune system attacks the body's own tissues) or a blood vessel condition. It affects men and women, and it can run in families in some cases.

Symptoms

Common symptoms

• Puffiness around the eyes, especially first thing in the morning
• Swelling in the feet, ankles, legs, or sometimes the belly
• Urine that looks frothy or foamy (a sign of protein leaking through)
• Urine that is pink, red, or cola-coloured from blood
• Passing less urine than usual
• High blood pressure, sometimes with headaches
• Feeling very tired or short of breath
• Feeling sick, or losing interest in food
• Unexplained weight gain from extra fluid

Symptoms in children

• Puffy eyelids or a puffy face in the morning
• Dark or cola-coloured urine
• Passing much less urine than usual
• Swollen tummy or ankles
• Tummy pain, fever, or feeling generally unwell
• Often appearing one to three weeks after a sore throat or a skin infection
• Some children have no symptoms at all and it is picked up on a urine test

Symptoms in older adults

• Breathlessness and leg swelling may be the most noticeable signs
• Tiredness that is put down to age or other illnesses
• Confusion or feeling generally unwell, which can be an early sign in older people
• Blood pressure that is harder to control than before
• Symptoms that overlap with heart, liver, or circulation problems, so tests are important

Causes

Main causes

• The immune system attacking the kidney filters by mistake. This is the most common underlying reason.
• An infection that triggers the immune system, such as a streptococcal throat or skin infection, or some viral infections
• IgA nephropathy, where a body protein called IgA builds up in the kidney filters, often after colds or sore throats
• Other conditions where the immune system attacks the body, such as lupus or vasculitis (inflammation of blood vessels)
• Some medicines, including certain painkillers and some treatments for other illnesses
• Inherited conditions, such as Alport syndrome, which affect the structure of the filters
• Problems with the immune system such as abnormal antibody proteins, which are more common in older adults

Risk factors

• A recent throat or skin infection
• Having an autoimmune condition such as lupus
• A family history of kidney disease
• Diabetes or high blood pressure, which put extra strain on the kidneys
• Long-term use of certain medicines without checking with a doctor or pharmacist
• Smoking and obesity, which make kidney damage more likely over time
• Being of certain ethnic backgrounds, where some kidney conditions are more common

When to see a doctor

See a doctor urgently if:

• You notice blood in your urine
• Your face, hands, or legs swell up suddenly
• You are passing much less urine than usual
• You have a fever with pain in your side or back
• You feel very unwell, breathless, or unusually tired after an infection

Book a routine appointment if:

• Your urine often looks frothy or foamy
• You have mild swelling in your ankles or around your eyes that does not settle
• You have a family history of kidney problems
• You have lupus, vasculitis, or diabetes and want your kidney health checked
• You have been told before that there was blood or protein in your urine

Diagnosis

Your doctor will start by asking about your symptoms, your recent infections, your medicines, and your family history. They will check your blood pressure and ask for a urine sample. A simple urine dipstick test can show blood or protein in minutes. If the results suggest a kidney problem, you will usually be referred to a kidney specialist (a nephrologist) for further tests.

Tests that may be done

• Urine test (dipstick and laboratory analysis) to look for blood, protein, and other signs
• A urine protein test that measures how much protein is leaking over a day
• Blood tests to check how well the kidneys are filtering and to look at salt and fluid balance
• Blood tests that look for signs of immune activity or recent infection
• Blood pressure measurement, repeated over time
• An ultrasound scan to look at the size and shape of the kidneys
• A kidney biopsy, where a tiny sample of kidney tissue is taken with a thin needle and checked under a microscope. This is often the best way to find out exactly which type of glomerulonephritis you have.

What to expect at your appointment

Some tests are quick and simple, like a urine sample or a blood test. A kidney biopsy sounds daunting, but it is a short procedure done with local numbing, and you will usually be asked to rest for a few hours afterwards. Results from a biopsy can take a week or more. Waiting for answers can feel stressful, so it can help to write down your questions and bring someone with you to appointments.

Treatment

Treatment depends on the type of glomerulonephritis, how severe it is, and what is causing it. Some mild cases need only regular check-ups. Others need medicines to calm the immune system, protect the kidneys, or control blood pressure. The aim is to protect your kidneys, keep fluid and blood pressure balanced, and treat the underlying trigger.

Self-care at home

• Take your medicines exactly as prescribed, even when you feel well
• Check your blood pressure at home if your doctor suggests it, and keep a record
• Cut down on salt to help control blood pressure and fluid build-up
• Ask your pharmacist before taking any over-the-counter pain relief, as some can be hard on the kidneys
• Keep a simple note of your weight and any new swelling
• Attend all follow-up appointments and urine tests, even if you feel fine
• Stop smoking, and limit alcohol
• Ask your doctor about any herbal or supplement products before you start them

Medical treatments

Medical treatment usually focuses on three things. First, controlling blood pressure with blood pressure medicines that also help protect the kidneys. Second, reducing protein loss, which often uses the same medicines plus a diet lower in salt. Third, calming the immune system when the immune system is causing the damage; this may involve a course of medicines that damp down immune activity, and sometimes a procedure to filter antibodies out of the blood in more serious cases. Doctors may also prescribe water tablets (diuretics) to help clear extra fluid, and medicines to protect against infections while the immune system is being treated. If a trigger such as an infection is found, that is treated too. Your specialist team will explain which approach suits your type and how long treatment is likely to last.

When is surgery considered?

Surgery is not used to treat glomerulonephritis itself. A kidney biopsy is a short needle procedure rather than an operation. In a small number of people whose kidneys stop working well despite treatment, options such as dialysis (a machine that cleans the blood) or a kidney transplant may be discussed with the specialist team.

Living with this condition

Many people with glomerulonephritis live full, normal lives with regular check-ups. Your routine will usually include blood pressure checks, urine tests, and blood tests every few months. It helps to build these into your calendar and to keep a small folder of your results, so you can notice changes and ask good questions.

Lifestyle tips

• Stay active in a way that suits you, such as walking or swimming
• Eat a balanced diet, with less salt and fewer processed foods
• Keep to a healthy weight
• Drink enough fluid, but follow any advice your kidney team gives about fluid limits if your kidneys are struggling
• Get plenty of rest when you are having a flare-up
• Avoid smoking and keep alcohol within recommended limits
• Ask your doctor about travel, vaccinations, and pregnancy planning if these apply to you

Diet and exercise

There is no single diet that suits everyone with glomerulonephritis. Many people are advised to eat less salt to help with blood pressure and swelling. Some may also be given advice about protein, potassium, or phosphate. Ask your doctor if you should see a dietitian; a kidney dietitian can build a plan around the foods you actually like. Exercise is usually encouraged, and gentle, regular activity such as walking is a good starting point. Build up slowly if you have been unwell.

Mental health and emotional wellbeing

Being told you have a kidney condition can bring worry, and waiting for test results can be especially hard. It is very common to feel anxious or low at times. Some treatments, such as immune-calming medicines, can also affect your mood and sleep. These feelings matter and are worth mentioning to your doctor. Talking to friends, family, a counsellor, or a support group often helps a great deal. If you ever feel unable to cope or have thoughts of harming yourself, contact your local crisis line or emergency services straight away. You deserve support.

Prevention

Not all types of glomerulonephritis can be prevented, because many are caused by the immune system acting in ways we cannot control. But you can lower your risk and protect your kidneys: get throat and skin infections treated promptly, keep blood pressure and diabetes well controlled, avoid unnecessary medicines that can harm the kidneys, and ask your doctor about urine and blood pressure checks if you have a family history or an autoimmune condition.

Vaccines

Keeping up to date with recommended vaccinations is sensible, especially if you have a kidney condition or take medicines that calm the immune system. Some vaccines may work less well during certain treatments, and live vaccines may not be suitable. Always check with your kidney team or family doctor about which vaccines you need and when.

Screening programmes

There is no national screening programme for glomerulonephritis. However, a simple urine test and blood pressure check are worthwhile if you have a family history of kidney disease, lupus or vasculitis, diabetes, or long-standing high blood pressure. Ask your doctor whether testing is appropriate for you.

Complications

If left untreated

• Long-term kidney damage (chronic kidney disease), which can get worse slowly over time
• Kidney failure, where dialysis or a transplant may eventually be needed
• High blood pressure that is hard to control
• Heavy protein loss in the urine, leading to swelling and other problems (nephrotic syndrome)
• Extra strain on the heart and blood vessels
• A higher chance of infections, especially with immune-calming treatment

Long-term outlook

The outlook varies a lot depending on the type of glomerulonephritis, how early it is found, and how your body responds to treatment. Many people do very well, especially when it is caught early and blood pressure is kept in a healthy range. Some people need long-term treatment and monitoring, and a smaller number go on to need dialysis or a transplant. Regular follow-up gives you and your team the best chance of protecting your kidneys for years to come. If you are unsure about your own situation, your specialist can talk you through what is known about your type.

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