Glomerulonephritis

Also called Nephritis, IgA nephropathy, Inflammation of the kidney filters

Inflammation of the kidney's filters. Usually silent, and often found only because somebody tested the urine.

What it is

Inflammation of the glomeruli, the millions of tiny filters in the kidneys. It is a leading cause of chronic kidney disease and kidney failure in the UK.

There are many types. IgA nephropathy is the commonest worldwide and classically causes visible blood in the urine during a throat infection, a day or two after it starts rather than a week later as in post-streptococcal disease. Others follow infections, accompany lupus or vasculitis, or arise on their own.

The defining problem is that it is usually silent. Damage shows up as blood and protein in the urine long before anybody feels unwell, which is why a routine urine dipstick is such a valuable and undervalued test.

**Protein in the urine is the finding that predicts kidney failure**, and it is also the one that treatment targets. Controlling blood pressure and reducing protein leak with ACE inhibitors or ARBs slows progression substantially, whatever the underlying type.

Rapidly progressive glomerulonephritis destroys kidney function within weeks and is a medical emergency, usually accompanying vasculitis or lupus. Blood in the urine plus a rising creatinine plus feeling unwell needs urgent nephrology input, not a repeat test in a month.

A kidney biopsy is usually needed to identify the type, and the type determines whether immunosuppression is used.

Signs you might notice

Often nothing at all.

Blood in the urine, either visible, making it cola, tea or pink coloured, or found only on a dipstick.

Frothy or foamy urine, from protein.

Swelling of the ankles, legs, hands or around the eyes. See oedema.

High blood pressure, sometimes as the only sign.

Passing less urine.

Tiredness, nausea, poor appetite.

Urgent: visible blood in the urine with feeling unwell; rapidly increasing swelling; breathlessness; or a rising creatinine on a blood test.

Any visible blood in the urine at any age also needs investigation for bladder cancer; the two possibilities are looked for together.

How it can affect day-to-day life

The silence is the hardest part psychologically. People are told they have a serious kidney condition while feeling entirely well, and asked to take tablets and attend appointments for a problem they cannot feel.

Blood pressure control is the treatment that does most of the work, and targets are tighter than for the general population.

Salt reduction genuinely helps, more than fluid restriction in most cases.

Anti-inflammatory painkillers should generally be avoided; they worsen kidney function and are widely bought over the counter.

Where immunosuppression is used, infection risk, bone protection and vaccination all become part of the picture.

For younger people, the prospect of eventual dialysis or transplant sits in the background for decades, and psychological support is rarely offered.

Pregnancy needs planning with a nephrologist, because both the disease and several of its treatments matter.

Supporting someone well

Do the urine test. A dipstick showing blood or protein in someone who feels well is the whole detection system.

Ask for the urine protein to be quantified, not just noted, and ask what the target is.

Control blood pressure aggressively and take the ACE inhibitor or ARB even while feeling well.

Reduce salt.

Avoid anti-inflammatory painkillers, including over-the-counter ibuprofen.

Get visible blood in the urine assessed urgently, and expect investigation for both kidney and bladder causes.

Ask about kidney biopsy and what type it is; the type determines treatment.

Keep vaccinations up to date, especially before immunosuppression.

Plan pregnancy with a nephrologist.

Where to get help

A GP practice for urine and blood tests and referral to nephrology.

Urgent nephrology assessment for rapidly worsening kidney function.

Kidney Care UK run a helpline and cover living with kidney disease.

Kidney Research UK for background information.