GPAtlas🧭 When to suspect
Glomerulonephritis (GN) is a group of mostly immune-mediated disorders in which inflammation damages the glomeruli – the kidney's filtering units. It is not one disease but a final common pathway for conditions ranging from IgA nephropathy (immunoglobulin A nephropathy, the commonest primary GN) to lupus and the small-vessel vasculitides.
The two cardinal urinary findings are haematuria (visible or non-visible) and proteinuria, and their combination – particularly with reduced kidney function – should always raise the possibility of glomerular disease. GN usually declares itself as one of two clinical pictures: a nephritic syndrome (an inflammatory, “active” urine) or a nephrotic syndrome (a heavy-protein-leak picture). Many patients sit between the two, and some are picked up only on an incidental abnormal urine dip or blood test.
The job in primary care is fourfold: recognise the pattern, never miss rapidly progressive disease, refer for the diagnosis (kidney biopsy), and start supportive treatment that protects the kidney while specialists decide on immunosuppression.
| Nephritic syndrome (inflammatory) | Nephrotic syndrome (heavy proteinuria) |
|---|---|
|
• Haematuria – often visible, smoky or “coca-cola”; dysmorphic red cells and red-cell casts. • Proteinuria, usually sub-nephrotic. • Hypertension and oliguria. • Rising creatinine / AKI is common. • Typical causes: IgA nephropathy, post-streptococcal GN, ANCA or anti-GBM vasculitis, lupus nephritis. |
• Heavy proteinuria – uPCR > 300 mg/mmol (≈ > 3.5 g/24h); frothy urine. • Hypoalbuminaemia (albumin < 30 g/L). • Marked oedema – periorbital, peripheral, ascites. • Hyperlipidaemia; kidney function often preserved early. • Typical causes: minimal change disease (children), membranous nephropathy (adults), FSGS, diabetic kidney disease. |
Suspect GN in anyone with unexplained haematuria and proteinuria, unexplained acute kidney injury (AKI) or chronic kidney disease (CKD), new oedema, or new hypertension in a young person. A history of recent infection (streptococcal sore throat or skin infection) or features of systemic disease – rash, joint pain, haemoptysis – points towards a specific cause.
Source: UK Kidney Association · NICE NG203
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