nephritis that comes and goes

Overview

Nephritis is inflammation (swelling and irritation) in the kidneys. When this inflammation comes and goes, it means you have times when your kidneys are inflamed (a flare) and times when they calm down (remission). The kidneys filter waste from your blood and control your body’s fluid balance. Repeated flares can harm your kidneys over time, but with proper care, many people manage well.

Nephritis that comes and goes is not very common, but it is a well-known type of kidney inflammation. The most common form is IgA nephropathy, which affects about 2–5 people per 10,000 worldwide.

It can affect people of any age, but it is most often seen in younger adults (teens to early 30s). Men are slightly more likely to get IgA nephropathy. Lupus nephritis is more common in women and people of African, Asian, or Hispanic descent.

Symptoms

Common symptoms

• Blood in your urine (often only seen under a microscope, but sometimes the urine looks pink, red, or cola-colored)
• Foamy or bubbly urine (due to protein leaking into the urine)
• Swelling in your hands, feet, ankles, or around your eyes
• High blood pressure
• Feeling very tired or generally unwell

Symptoms in children

• Blood in the urine (often seen during a urine test for an infection or check-up)
• Swelling around the eyes, especially in the morning
• Not eating well or feeling sick
• Bedwetting that was not happening before

Symptoms in older adults

• Swelling in the legs and ankles that does not go away
• Shortness of breath (if fluid builds up around the lungs)
• Confusion or trouble thinking clearly (if kidney function drops)
• High blood pressure that is hard to control
• Less urine than usual

Causes

Main causes

• Problems with the immune system attacking the kidneys (autoimmune diseases like IgA nephropathy or lupus nephritis)
• Infections (such as strep throat, hepatitis, or endocarditis) that trigger kidney inflammation
• Certain medications or vaccines (rarely) causing a reaction
• In some cases, no clear cause can be found

Risk factors

• Having an autoimmune condition (like lupus, rheumatoid arthritis, or vasculitis)
• A family history of kidney disease or certain autoimmune diseases
• Recent infection (especially strep throat or skin infections)
• Being a young adult or a middle-aged adult
• Being of a certain ethnic background (for example, IgA nephropathy is more common in people of East Asian or White descent)

When to see a doctor

See a doctor urgently if:

• If you have any of the emergency symptoms listed above (call your local emergency number)
• If you see blood in your urine that you can see with your eyes and you also have pain, fever, or trouble peeing

Book a routine appointment if:

• If you notice swelling in your hands, feet, or face that lasts more than a few days
• If you have foamy urine that does not go away
• If you feel very tired or sick for no clear reason
• If your blood pressure is higher than usual or you have new high blood pressure readings
• If you have a known kidney condition and your symptoms change or get worse

Diagnosis

Your doctor will diagnose nephritis based on your symptoms, a physical exam, and several tests. Because it comes and goes, they may need to follow you over time to see the pattern.

Tests that may be done

• Urine tests (for blood, protein, and signs of inflammation)
• Blood tests (to check kidney function – creatinine, eGFR – and look for immune system activity)
• Blood pressure checks (high blood pressure is common with kidney disease)
• Kidney ultrasound (to see the size and structure of your kidneys)
• Kidney biopsy (taking a tiny sample of kidney tissue to look for the type of inflammation) – this is the most definite test

What to expect at your appointment

Most tests are simple and done in a clinic or lab. A kidney biopsy is a short procedure done with local numbing medicine – you will be awake but the area is numb. The results can take a few days to a week. Your doctor will explain what the results mean and what treatment steps to take.

Treatment

Treatment for nephritis that comes and goes focuses on controlling inflammation, protecting your kidneys from lasting damage, and managing symptoms. The type of treatment depends on the cause and how severe the flares are. Mild cases may only need monitoring, while more active disease may need medicines that calm the immune system.

Self-care at home

• Take all medicines exactly as prescribed, even when you feel well
• Check your blood pressure regularly at home and keep a log
• Avoid non-steroidal anti-inflammatory drugs (like ibuprofen, naproxen) unless your doctor says it is safe
• Protect yourself from infections by washing hands and staying up to date on vaccines (like flu and pneumonia shots)
• Drink enough water unless your doctor tells you to limit fluids

Medical treatments

Doctors may prescribe medicines to lower blood pressure (such as ACE inhibitors or angiotensin receptor blockers) to protect kidney function. For immune-related nephritis, they might use corticosteroids or other medicines that reduce inflammation, or medicines that suppress parts of the immune system. These treatments are closely monitored. You should never stop or change your medicines without talking to your doctor.

When is surgery considered?

Surgery is rarely needed for nephritis itself. However, if kidney damage becomes severe and leads to kidney failure, treatments like dialysis or a kidney transplant may be needed in the long term. That is not common for people who get good early care.

Living with this condition

Living with nephritis that comes and goes means learning to recognize flares and taking care of your kidneys between flares. You will need regular check-ups, typically every few months. Keep a diary of your symptoms, blood pressure, and any changes. This helps you and your doctor manage your condition better.

Lifestyle tips

• Stay active, but rest when you are tired or during a flare
• Manage stress with relaxation techniques like deep breathing, meditation, or gentle yoga
• Avoid smoking and limit alcohol, as these can worsen kidney damage
• Talk to your doctor before taking any over-the-counter medicines or supplements

Diet and exercise

A kidney-friendly diet is often recommended, which may include limiting salt (to help control blood pressure and swelling), eating moderate amounts of protein, and staying hydrated. Your doctor or a dietitian can give you specific advice. Gentle exercise like walking is usually fine, but ask your doctor about more intense activity, especially during a flare.

Mental health and emotional wellbeing

Living with a relapsing condition can be stressful and worrying. It is normal to feel anxious or down, especially during a flare. Talk to your doctor or a mental health professional if you are struggling. If you feel hopeless or have thoughts of harming yourself, reach out for crisis support right away – contact a crisis helpline or go to your nearest emergency room.

Prevention

You cannot always prevent nephritis, especially if it is caused by an immune system problem. But you can reduce the number of flares and slow kidney damage by managing your overall health: control blood pressure, avoid infections, and follow your treatment plan. Treating any underlying conditions (like lupus) can also help.

Vaccines

Stay up to date on recommended vaccines, especially the flu shot, pneumonia vaccine, and the COVID-19 vaccine. These can help prevent infections that might trigger a flare. Ask your doctor which vaccines are right for you.

Screening programmes

If you have a family history of kidney disease or an autoimmune condition, talk to your doctor about regular urine tests and blood pressure checks. Early detection of nephritis can make a big difference.

Complications

If left untreated

• Progressive kidney damage that can lead to chronic kidney disease (CKD)
• High blood pressure that is hard to control
• Nephrotic syndrome (large amounts of protein in the urine, swelling, and high cholesterol)
• Kidney failure, which may require dialysis or a kidney transplant

Long-term outlook

With proper treatment and monitoring, many people with nephritis that comes and goes can live full, active lives. Flares can be managed, and kidney function can often be preserved for many years. The key is to work closely with your healthcare team and stick to your treatment plan. While some people may eventually need more advanced care, most can avoid kidney failure with good management.

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