🫘 Patient Education & Counselling — Glomerulonephritis (GN)

What is Glomerulonephritis?

How the Kidneys Are Affected — What Goes Wrong?

Light microscopy of a renal biopsy showing proliferative glomerulonephritis — note the increased cellularity inside the glomerular tuft

What Causes Glomerulonephritis?

🦠 Infections

• Streptococcal throat infection or skin infection (impetigo) — the most classic cause in children (post-streptococcal GN)
• Hepatitis B → membranous or membranoproliferative GN
• Hepatitis C → cryoglobulinemic GN, membranoproliferative GN
• Bacterial endocarditis (infection of heart valves)
• HIV, malaria, schistosomiasis

🔁 Autoimmune / Systemic Diseases

• Systemic Lupus Erythematosus (SLE)
• IgA vasculitis (Henoch-Schönlein purpura)
• Granulomatosis with polyangiitis (Wegener's)
• Microscopic polyangiitis
• Goodpasture's disease

💊 Drugs and Toxins

• Hydralazine, levamisole-adulterated cocaine, penicillamine, gold therapy

🧬 Inherited/Other

• Alport syndrome (genetic disorder of collagen IV in the glomerular basement membrane)
• IgG4-related kidney disease
• C3 glomerulopathy (complement-driven)

Who Gets Glomerulonephritis?

• Post-streptococcal GN is most common in children aged 3–10 years, though it can affect all ages
• About 10–15% of people with nephritogenic streptococcal infection develop GN
• In younger children, the trigger is often skin infection (impetigo); in older children and adults, it is more commonly throat infection (pharyngitis)
• Autoimmune and IgA-related forms are more common in adults

Symptoms — What You Might Notice

⚠️ Warning signs: If you develop sudden, severe reduction in urine output, or urine that looks like cola/blood — seek immediate medical attention. Some forms of GN can progress to kidney failure within days to weeks if untreated.

How is it Diagnosed?

Blood Tests

• Serum creatinine & urea — to assess kidney function
• Complement levels (C3, C4) — low in post-streptococcal GN, lupus, MPGN
• Anti-streptolysin O (ASO) titre — elevated after streptococcal infection
• ANA, anti-dsDNA — for lupus
• ANCA (MPO / PR3) — for vasculitis-associated GN
• Anti-GBM antibodies — for Goodpasture's disease
• Immunoglobulins — IgA, IgG levels

Urine Tests

• Urine microscopy — reveals red blood cell (RBC) casts (the hallmark of GN), granular casts, white cells
• Urine protein-to-creatinine ratio — quantifies protein loss
• 24-hour urine protein collection

Kidney Biopsy

• Often essential for definitive diagnosis
• A small needle removes a tiny piece of kidney tissue, which is examined under light microscopy, immunofluorescence, and electron microscopy to identify the exact type of GN

Renal biopsy (H&E stain) showing a cellular crescent in Bowman's space — this is seen in rapidly progressive glomerulonephritis (RPGN), a medical emergency

Types of Glomerulonephritis

Treatment

🔵 General Supportive Measures (for most types)

• Low-salt diet — reduces fluid retention and blood pressure
• Fluid restriction — if significant oedema or reduced urine output
• Protein restriction — reduces load on damaged kidneys
• Loop diuretics (e.g., furosemide) — to remove excess fluid
• ACE inhibitors or ARBs — lower blood pressure AND reduce protein leakage; protect the kidneys long-term
• Blood pressure control — critical to slow progression

🔴 Specific Immunosuppressive Therapy

• Corticosteroids (prednisolone) — cornerstone for autoimmune and inflammatory GN types
• Cyclophosphamide — used for severe lupus nephritis, ANCA vasculitis, anti-GBM disease
• Rituximab — increasingly used for ANCA vasculitis and membranous nephropathy
• Mycophenolate mofetil (MMF) — used in lupus nephritis and other immune GN
• Plasma exchange (plasmapheresis) — urgently removes harmful antibodies in Goodpasture's disease and severe ANCA vasculitis

🟡 Anticoagulation

• If heavy protein loss (nephrotic range) occurs, clotting risk rises — anticoagulant therapy may be prescribed

Prognosis — What to Expect

Living With Glomerulonephritis — Patient Guidance

🍽️ Diet

• Reduce salt — aim for < 2 g sodium/day; avoid processed foods, canned soups, pickles
• Limit potassium (bananas, oranges, potatoes) if kidney function is reduced
• Limit phosphate (dairy, cola drinks) if creatinine is elevated
• Adequate calories to prevent muscle wasting — work with a renal dietitian

💊 Medications

• Take all prescribed medications as directed
• Avoid NSAIDs (ibuprofen, naproxen, diclofenac) — these can worsen kidney function
• Avoid contrast dyes for imaging if possible without pre-hydration — inform your radiologist
• Report any new medications (even herbal/OTC) to your nephrologist

🩺 Monitoring

• Regular blood pressure checks (target usually < 130/80 mmHg)
• Routine blood tests: creatinine, electrolytes, urine protein
• Follow-up urine microscopy — improvement in RBC casts signals response to treatment

🚫 Lifestyle

• Stop smoking — smoking worsens kidney and cardiovascular disease
• Limit alcohol
• Exercise moderately — as tolerated; avoid strenuous activity during acute flares
• Avoid unnecessary infections — infections can trigger GN flares (especially in IgA nephropathy)

🤰 Pregnancy

• GN can worsen during pregnancy and increase risks to mother and baby
• Discuss with your nephrologist before planning a pregnancy
• Some immunosuppressants are contraindicated in pregnancy

When to Seek Urgent Medical Help

• 🔴 Sudden dramatic decrease in urine output
• 🔴 Urine that appears bright red or very dark (cola-coloured)
• 🔴 Severe, rapidly worsening swelling
• 🔴 Severe headache with vision changes (hypertensive emergency)
• 🔴 Breathlessness (especially in Goodpasture's — may indicate lung haemorrhage)
• 🔴 Confusion or extreme fatigue (signs of uraemia)

Key Takeaways

1. Glomerulonephritis is inflammation of the kidney's filtering units, most often immune-mediated
2. Causes range from strep infections to autoimmune diseases to medications
3. Cardinal signs are blood and protein in the urine, swelling, and raised blood pressure
4. A kidney biopsy is often needed to confirm the exact type and guide treatment
5. Treatment ranges from supportive measures to powerful immunosuppression, depending on type
6. Post-streptococcal GN in children has an excellent prognosis; other forms need long-term follow-up
7. Protect your kidneys: control blood pressure, avoid NSAIDs, follow your prescribed plan, and attend regular check-ups

📋 Patient Education Sheet — Glomerulonephritis (GN)

What is it?

What Causes It?

• Infections — strep throat, skin infections, hepatitis B or C
• Autoimmune diseases — lupus, IgA vasculitis, Goodpasture's disease
• Antibody-mediated injury — anti-GBM disease, ANCA vasculitis
• Drugs — hydralazine, certain others

Symptoms to Watch For

How is it Diagnosed?

• Urine test — checks for blood, protein, and RBC casts
• Blood tests — kidney function, complement, antibodies (ASO, ANCA, ANA, anti-GBM)
• Kidney biopsy — the definitive test to identify the exact type

Treatment

• Low-salt, low-fluid diet
• Blood pressure control (ACE inhibitors / ARBs)
• Loop diuretics for swelling

• Corticosteroids (prednisolone)
• Cyclophosphamide, Rituximab, or Mycophenolate
• Plasma exchange (for Goodpasture's / severe ANCA)

Prognosis

• Post-strep GN in children → 95% fully recover within 8–12 weeks ✅
• IgA nephropathy → variable; needs long-term follow-up
• Rapidly progressive GN → medical emergency; requires urgent treatment
• Membranoproliferative GN → >70% risk of chronic kidney failure over time

Daily Life Tips

🚨 Go to Emergency Immediately If:

• Urine is bright red or you stop urinating
• Severe facial/body swelling develops suddenly
• You develop breathlessness (may suggest lung involvement)
• Severe headache with visual changes
• Confusion or extreme fatigue

Questions to Ask Your Doctor

1. What type of GN do I have?
2. Do I need a kidney biopsy?
3. Which medications should I avoid?
4. How often do I need blood/urine monitoring?
5. Can my kidney function recover fully?
6. Is my condition hereditary — should my family be tested?