Ask an expert: What is glomerulonephritis?

Glomerulonephritis is a term for diseases which primarily affect the kidney’s filters, known as glomeruli. In this informative article, leading consultant nephrologist Dr James Pattison gives expert insight on the causes behind glomerulonephritis, its symptoms and the positive impact lifestyle changes can have as part of a treatment plan.

What causes glomerulonephritis?

There are a number of causes behind glomerulonephritis. A range of diseases which purely affect the kidneys, known as primary glomerular diseases, are classified according to the appearances of the glomeruli on kidney biopsy. The most common examples of primary glomerular diseases are:

• minimal change disease
• membranous nephropathy
• focal and segmental glomerulosclerosis
• IgA nephropathy

These diseases vary greatly in terms of response to treatment and outcomes. Secondary glomerular diseases are part of multi-system diseases. These include conditions such as diabetes, vasculitis, lupus and myeloma. Specific blood tests can indicate a diagnosis. However, in general a renal biopsy is needed in adults to diagnose the type of glomerular disease and guide treatment. A renal biopsy is generally not needed in patients with presumed diabetic nephropathy.

What are the symptoms of glomerulonephritis?

The symptoms of glomerulonephritis can be very variable. Some people experience no symptoms at all and abnormalities are picked up on a urine test, such as blood or protein in the urine or an abnormality of the kidney function.

Patients with more advanced glomerulonephritis conditions may present with swelling in the feet, legs and ankles which is most noticeable later in the day or with swelling of the eyelids which is most apparent in the mornings. In the most serious cases, patients can present with advanced kidney disease and symptoms of kidney failure.

How serious can it become if left untreated?

As the term glomerulonephritis covers a wide variety of conditions, the outcome is very variable. At one end of the spectrum, there are patients with minor abnormalities in the urine which persist for life but do not cause any symptoms. Most commonly, there are patients with kidney diseases that progress very slowly over years and decades. This applies to the most common glomerular disease IgA nephropathy.

Much less common but importantly, we see patients with a rapidly progressive glomerulonephritis whose kidney function is deteriorating fast who need to be treated very urgently to stop permanent and irreversible kidney damage from occurring.

How is glomerulonephritis most effectively treated?

There are some effective lifestyle measures that patients with glomerulonephritis can take, including:

• losing excess weight
• controlling their blood pressure
• taking exercise
• stopping smoking

These measures are very important because they can dramatically slow down the progression of kidney disease.

Over the last twenty years, the principal treatment for people with protein in the urine due to glomerulonephritis has been a certain class of blood pressure tablets, called ACE inhibitors or Angiotensin receptor blockers, which have been shown to slow down the progression of kidney disease. Recently, SGLT2 inhibitors have been shown to slow deterioration of kidney function and are increasingly going to be used in glomerulonephritis patients.

For specific kidney diseases, however, specialised treatments are required. Minimal change disease, for example, generally needs to be treated initially with steroids or Tacrolimus. Other similar diseases also respond to immunosuppression and historically we have prescribed steroids and drugs such as those used in transplant medicine, like Mycophenolate or Tacrolimus to effectively treat the disease. Increasingly, monoclonal antibody therapies are being prescribed, such as Rituximab as they have fewer side-effects. It is an exciting and innovative time in the field and many treatments are being developed to improve the quality of life and prognosis of patients with glomerular diseases.

If you are seeking treatment for glomerulonephritis or would like more information, don’t hesitate to book a consultation with Dr Pattison by visiting his Top Doctors profile.