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.
GN 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).
• 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.
In general practice:
• Recognise the pattern.
• Never miss rapidly progressive disease.
• Refer for the diagnosis (kidney biopsy).
• 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 or acute kidney injury (AKI) is common. |
• 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: IgA nephropathy, post-streptococcal GN, anti-neutrophil cytoplasmic antibody (ANCA) or anti-GBM vasculitis, lupus nephritis. |
• Typical causes: minimal change disease (children), membranous nephropathy (adults), focal segmental glomerulosclerosis (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.
• 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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