Glomerulonephritis
Glomerulonephritis is damage to the kidney's filters, the microscopic tufts of vessels through which blood is cleaned.
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Medicines commonly prescribed for Glomerulonephritis
For informational purposes only. Always consult a doctor before using any medicine.
Dosage form: TABLET, 2.5 mgActive substance: ramiprilManufacturer: Sandoz Farmaceutica S.A.Prescription requiredDosage form: TABLET, 10 mgActive substance: ramiprilManufacturer: Laboratorios Cinfa S.A.Prescription requiredDosage form: TABLET, 10 mgActive substance: ramiprilManufacturer: Teva Pharma S.L.U.Prescription required
Glomerulonephritis is damage to the kidney's filters, the microscopic tufts of vessels through which blood is cleaned. What usually destroys them is not an infection but the person's own immune system, which has mistaken kidney tissue for something foreign. This is not one disease but a whole family: the same name covers mild forms found by chance on a urine test and lived with for decades, and fast ones that consume the kidneys in a matter of weeks. Hence the central idea of this page: glomerulonephritis is told apart not by its name but by the speed at which it moves, and everything depends on that speed.
What exactly breaks
The kidney works as a set of sieves: each holds about a million glomeruli, and more than a hundred litres of blood pass through them daily. The sieve lets water and small waste products go and holds back the large items, the blood proteins and red cells. When a glomerulus becomes inflamed the mesh tears, and through the holes escapes what should have stayed:
- red cells — the urine turns pink, the colour of strong tea or cola, though more often the blood shows only under a microscope;
- protein — the urine froths like beer, and the froth is slow to settle.
From there the picture takes one of two paths. If mostly blood is leaking, the blood pressure rises, the face puffs up and the urine dwindles. If protein is leaking, and a lot of it, the blood runs short of albumin and water shifts out of the vessels into the tissues: the eyelids fill up in the morning, the legs and abdomen swell by evening. That is called nephrotic syndrome. Along the way the liver drives up the cholesterol and the blood becomes prone to clotting, which is why the treatment is not confined to the kidney.
The signs that give it away
Mild glomerulonephritis does not hurt and shows nothing: it turns up when urine is tested before an operation, at a health check or in pregnancy. That is precisely why an abnormal result with no complaints is not something to wave away but something to sort out. When signs do appear, they look like this:
- the urine darkens to the colour of tea, cola or meat washings;
- persistent froth in the toilet that does not clear by itself;
- swelling: the eyelids first thing in the morning, then the lower legs and feet by evening, with the sock elastic leaving a mark;
- noticeably less urine on the same amount of drinking;
- raised blood pressure, particularly if there was none before;
- tiredness that rest does not shift, nausea, loss of appetite and weight;
- breathlessness on exertion and when trying to lie flat.
Some of the diseases that cause glomerulonephritis hit more than the kidney, so alongside there may be a rash, joint pain, a long low-grade fever, mouth ulcers, hair loss, abdominal pain and yellowing of the skin and the whites of the eyes.
When waiting is not an option
There is a form called rapidly progressive: the kidneys shut down not over years but over weeks, and the lost time cannot be made up afterwards. Seek help the same day, and call an ambulance if the state is severe — across Europe the single number is 112 — if any of the following appears:
- hardly any urine, or none at all;
- coughing up blood together with breathlessness and altered urine: that combination belongs to the rare but most dangerous causes of glomerulonephritis, the ones that strike lung and kidney at once;
- swelling building over a few days, difficulty breathing lying down, extra pillows needed;
- very high blood pressure with severe headache, flashing in the vision, confusion or fits;
- pain and swelling of one calf, or sudden chest pain with shortness of breath — that is how a clot announces itself, and the risk is high when a lot of protein is being lost;
- fever with a rash and joint pain on top of dark urine.
In every other case — visible blood in the urine, persistent froth, new swelling — a doctor is needed within days, but not an ambulance. Blood in the urine does not always mean glomerulonephritis; it has many causes, and all of them need to be explained rather than waited out.
What sets it off
The cause cannot always be named, but it has to be looked for, because the treatment follows from it.
- The immune system itself. The commonest variant worldwide is the deposit of class A antibodies in the glomeruli. It is recognised by its script: the urine goes dark during a cold or a day or two afterwards, not weeks later.
- After streptococcus. One to three weeks after tonsillitis, or a month after a pus-forming skin infection, mostly in children. It usually settles and leaves the kidneys sound.
- Systemic diseases. Lupus and the small-vessel vasculitides, in which the kidney is only one organ on the list.
- Chronic infections. Hepatitis B and C, HIV, drawn-out inflammation of the heart's inner lining, a long-standing pocket of pus.
- Medicines and tumours. Certain drugs and some cancers set off the same mechanism, and occasionally the kidney changes are found before the tumour is.
- Inherited forms. Rare but recognisable: blood in the urine across several generations, and in the men of the family also hearing loss and changes in the eyes. Where this turns up, all blood relatives are worth testing.
How the diagnosis is made
It starts with tests, and they give more than one would expect:
- urine — whether there is blood and protein, and how much protein is being lost. Under the microscope the search is for misshapen red cells and casts, which show that the blood came from the glomerulus and not from the bladder;
- blood — creatinine and the filtration rate calculated from it show how much kidney is still working; albumin, cholesterol and potassium are looked at too;
- immunological tests, which point to the particular disease sitting behind the inflammation;
- ultrasound, to judge the size of the kidneys and rule out a stone or an obstruction to the outflow of urine;
- biopsy — under local anaesthetic and ultrasound guidance a fine needle takes a tiny core of tissue. It sounds alarming, but it is what answers the questions that matter: which form this is, how far it has gone, and whether hard treatment is justified.
If filtration is falling quickly the work-up is not spread out: the biopsy is done urgently, because treating those forms only makes sense while the glomeruli are still alive.
How it is treated
Treatment comes in two parts, and both count. The first tries to stop the process; the second protects the kidney, is needed whatever the form, and runs for years.
- Pressure and protein. The foundation. Drugs that block the renin-angiotensin system lower the blood pressure and at the same time cut protein loss, slowing the scarring of the kidney; it is for that second effect that they are prescribed even when the pressure is not especially high. Recent years have added further classes that protect the kidney beyond the pressure they lower.
- Damping the immune system. Where the fault is immune, steroids and other immunosuppressants are used, including targeted agents. They do work, but they remove the defences against infection and carry their own consequences, from thinning bone to rising blood sugar, so they go not to everyone but to those who would otherwise lose their kidneys.
- Treating the cause. Antivirals for viral hepatitis, antibiotics and sometimes surgery for infection of the heart, cancer treatment where there is a tumour. Remove the cause and the kidney inflammation often quietens by itself.
- Dealing with the consequences. Diuretics for swelling, statins for high cholesterol and, where protein loss is heavy, drugs that reduce the risk of clots.
- Cleaning the plasma. In some severe forms the blood is run through a machine that separates off the plasma with the harmful antibodies and returns the cells. It is held in reserve, for strict indications.
- Replacing the function. If the kidneys could not be saved, dialysis takes over their work, and the best answer remains a transplant. Preparation for that begins early, not at the last moment.
Life after the diagnosis
A great deal here depends not on medicines but on everyday matters, and their effect is not symbolic.
- Salt. Cutting it is the most effective thing that can be done at home to bring the pressure down and clear the swelling. Most salt comes not from the cellar on the table but from bread, cured meats, cheese, sauces and ready meals.
- Painkillers. The usual anti-inflammatory tablets are unwelcome with a damaged kidney, because they worsen the blood flow through the glomeruli. Ask the doctor what to use for pain instead.
- Smoking. It speeds up the loss of kidney tissue and adds cardiovascular risk on top of the renal one, and in this illness that risk is already raised.
- Diet. There is no single diet. Restriction of protein, potassium, phosphate and fluid is prescribed case by case, from the results and the stage; with a mild form, extra prohibitions only do harm. Drinking less on your own initiative is not required.
- Blood pressure at home. Get a monitor and a notebook: a month of readings tells the doctor far more than one measurement in the clinic.
- Vaccination. Infections run harder here and immunosuppressants add to the vulnerability, so influenza and pneumococcal vaccination are usually advised. Live vaccines are not given under immunosuppression; timing is a question for the doctor.
On the outlook, honestly: some forms clear without trace, some can be held in balance for a lifetime, and some lead slowly to chronic kidney disease. The outcome is decided by the type, by how much protein is in the urine and by how steadily the blood pressure is held, and the last two are things you influence directly. Mention it separately if you are planning a pregnancy: with glomerulonephritis it is managed together with a kidney specialist, and some medicines are changed beforehand.
Online consultation
Remotely it is easy to do the very thing this illness usually begins with: go through the urine test that showed protein or red cells and work out whether the finding is worrying and which investigations come next. The doctor reads your results in sequence, explains what the filtration rate means and why these particular drugs were chosen, helps make sense of the blood pressure diary and goes over what to do about swelling and which medicines are unkind to the kidney. An online appointment also suits long follow-up, once the diagnosis is settled and the question is control. Examining you, taking blood and performing a biopsy cannot be done through a screen, and the signs in the urgent section are not discussed remotely at all: with those you seek help straight away.
This material is for information only and does not replace medical advice.
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Discuss your symptoms and possible next steps for Glomerulonephritis with a doctor online.
