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Glomerulonephritis is inflammation of the glomeruli, the microscopic filters inside the kidney that separate waste and excess water from the blood. When these filters are damaged they lose their selectivity, so protein and red blood cells leak into the urine and the kidney's ability to clear the blood declines. Signs that call for assessment include urine the colour of tea or cola or visible blood in it, heavy foam in the urine indicating protein leakage, puffiness around the eyes in the morning and swelling of the feet and legs, high blood pressure even in a young person, reduced urine volume and unexplained fatigue. Sometimes the inflammation causes no symptoms at all and is found incidentally on a routine urine test, which is precisely why urine testing belongs in a periodic check-up. The causes are varied: immune-mediated disease in which the immune system attacks kidney tissue; inflammation following a bacterial throat or skin infection some two to three weeks earlier; deposition of certain antibodies within the glomeruli; systemic disease such as lupus or vasculitis; and aggravating factors such as hypertension and diabetes. Identifying the type matters because treatment differs greatly from one type to another. Diagnosis therefore relies on urine testing with albumin measurement, kidney function tests, immunological and viral screening, ultrasound imaging, and in many cases a kidney biopsy. The biopsy is a fine-needle procedure performed under local anaesthesia with imaging guidance, and it is the decisive test for defining the type of inflammation and the degree of scarring, and hence the treatment plan. Treatment combines addressing the cause with protecting the kidney: immunosuppressive medication or steroids in the immune types that benefit from them, treating the triggering infection where relevant, blood pressure medication that reduces protein leakage, salt restriction, and diuretics for swelling when needed. An important limit belongs here: not every type needs immunosuppression, since some are managed with supportive care and monitoring alone, and no treatment restores tissue that has already scarred. The aim is to stop active inflammation and slow decline. Avoid non-steroidal anti-inflammatory painkillers, herbal products and herbal stone-dissolving mixtures completely during the illness, because they add injury and can undermine treatment. Suitability for any medication or for biopsy is decided by clinical assessment and results, not by resemblance to someone else's case.
Assessment starts with blood pressure measurement, examination for swelling, listening to the chest, and review of recent infections and medications, followed by microscopic urine examination for red cells and casts, albumin measurement, and kidney function and electrolyte tests. This step establishes whether inflammation is active and how far function is affected.
Immunological tests are requested to look for systemic disease such as lupus or vasculitis, along with a throat swab or markers of previous infection, viral screening when indicated, and ultrasound to assess kidney size and exclude obstruction. These results narrow the diagnosis and guide whether a biopsy is required.
If testing is not enough to define the type, a kidney biopsy is taken with a fine needle under local anaesthesia and imaging guidance. It requires preparation including blood pressure control and review of blood-thinning medication, with observation for several hours afterwards. The biopsy result reveals the type of inflammation and extent of scarring, and it is what allows treatment to be chosen precisely.
Treatment is chosen by type: immunosuppression or steroids for the types that benefit, or supportive care alone for others, together with blood pressure medication that reduces protein leakage, salt restriction, diuretics for swelling and treatment of infection. Drug side effects are monitored closely, particularly with immunosuppression, which raises infection risk.
Urine tests, albumin and kidney function are repeated at set intervals to measure response, and medication is tapered gradually under supervision when improvement occurs. Follow-up continues for years in many types because relapse is possible, and patients are asked to return sooner if foam or blood in the urine or swelling reappears.
Bring every previous urine or blood test, even old ones, because protein or blood found on an earlier test changes the diagnosis. Write down the dates of any sore throat, skin infection or fever in recent weeks, and mention any rash, joint pain, hair loss or mouth ulcers, since these point to systemic disease. Tell your physician about all your medicines and supplements, and in particular stop non-steroidal anti-inflammatory painkillers, herbal products and herbal stone-dissolving mixtures, and do not restart them without approval. Mention any family history of kidney disease, deafness or blood in the urine. If a biopsy is planned, disclose blood thinners and aspirin, follow the fasting and blood pressure instructions given to you, and arrange for someone to take you home afterwards.
Keep the appointments for repeat urine, albumin and kidney function tests even after symptoms disappear, because relapse shows in the laboratory before you feel it. Reduce salt, pickles and processed food, keep to any fluid limit set for you, and weigh yourself regularly since rapid gain means retention. If you are on immunosuppression or steroids, never stop them or lower the dose on your own, avoid close contact with people who have infections, and report any fever. Seek urgent care if you develop: **a sharp drop in urine output**, **sudden swelling of the face and feet**, **blood in the urine**, **fever with flank pain**, breathlessness, severe headache with high blood pressure, swelling or pain in one leg, or bleeding or severe pain at the biopsy site.
An assessment visit usually takes 20 to 40 minutes, urine and kidney function results arrive within one to three days, and immunological tests may need about a week. The biopsy itself takes minutes, with several hours of observation afterwards and a tissue result within days. Treatment then runs over months, response is reviewed at set intervals, and follow-up continues for years in many types.
Dr Ismaeel Qatash is a consultant nephrologist with American board qualifications in internal medicine and nephrology. His practice includes kidney function ass…
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