Ask an expert: What is glomerulonephritis?

Written by: Dr James Pattison
Published:
Edited by: Sophie Kennedy

Glomerulonephritis is a term for diseases which primarily affect the kidney’s filters, known as glomeruli. In this informative article, leading consultant nephrologist Dr James Pattison gives expert insight on the causes behind glomerulonephritis, its symptoms and the positive impact lifestyle changes can have as part of a treatment plan.

 

 

What causes glomerulonephritis?

 

There are a number of causes behind glomerulonephritis. A range of diseases which purely affect the kidneys, known as primary glomerular diseases, are classified according to the appearances of the glomeruli on kidney biopsy. The most common examples of primary glomerular diseases are:

  • minimal change disease
  • membranous nephropathy
  • focal and segmental glomerulosclerosis
  • IgA nephropathy

 

These diseases vary greatly in terms of response to treatment and outcomes. Secondary glomerular diseases are part of multi-system diseases. These include conditions such as diabetes, vasculitis, lupus and myeloma. Specific blood tests can indicate a diagnosis. However, in general a renal biopsy is needed in adults to diagnose the type of glomerular disease and guide treatment. A renal biopsy is generally not needed in patients with presumed diabetic nephropathy.

 

 

What are the symptoms of glomerulonephritis?

 

The symptoms of glomerulonephritis can be very variable. Some people experience no symptoms at all and abnormalities are picked up on a urine test, such as blood or protein in the urine or an abnormality of the kidney function.

 

Patients with more advanced glomerulonephritis conditions may present with swelling in the feet, legs and ankles which is most noticeable later in the day or with swelling of the eyelids which is most apparent in the mornings. In the most serious cases, patients can present with advanced kidney disease and symptoms of kidney failure.

 

 

How serious can it become if left untreated?

 

As the term glomerulonephritis covers a wide variety of conditions, the outcome is very variable. At one end of the spectrum, there are patients with minor abnormalities in the urine which persist for life but do not cause any symptoms. Most commonly, there are patients with kidney diseases that progress very slowly over years and decades. This applies to the most common glomerular disease IgA nephropathy.

 

Much less common but importantly, we see patients with a rapidly progressive glomerulonephritis whose kidney function is deteriorating fast who need to be treated very urgently to stop permanent and irreversible kidney damage from occurring.

 

 

How is glomerulonephritis most effectively treated?

 

There are some effective lifestyle measures that patients with glomerulonephritis can take, including:

 

These measures are very important because they can dramatically slow down the progression of kidney disease.

 

Over the last twenty years, the principal treatment for people with protein in the urine due to glomerulonephritis has been a certain class of blood pressure tablets, called ACE inhibitors or Angiotensin receptor blockers, which have been shown to slow down the progression of kidney disease. Recently, SGLT2 inhibitors have been shown to slow deterioration of kidney function and are increasingly going to be used in glomerulonephritis patients.

 

For specific kidney diseases, however, specialised treatments are required. Minimal change disease, for example, generally needs to be treated initially with steroids or Tacrolimus. Other similar diseases also respond to immunosuppression and historically we have prescribed steroids and drugs such as those used in transplant medicine, like Mycophenolate or Tacrolimus to effectively treat the disease. Increasingly, monoclonal antibody therapies are being prescribed, such as Rituximab as they have fewer side-effects.

 

It is an exciting and innovative time in the field and many treatments are being developed to improve the quality of life and prognosis of patients with glomerular diseases.

 

 

 

If you are seeking treatment for glomerulonephritis or would like more information, don’t hesitate to book a consultation with Dr Pattison by visiting his Top Doctors profile.

By Dr James Pattison
Nephrology

Dr James Pattison is a leading consultant nephrologist based in London. His specialisms are urinary tract infections, diabetic kidney disease, hypertension, and all stages of chronic kidney disease. He also has a specialist interest in glomerular diseases and kidney transplantation. He privately practices at London Bridge Hospital, BMI The Blackheath Hospital and The Private Outpatients Consulting Rooms clinic in the capital. His NHS base is Guy's and St Thomas' NHS Foundation Trust, where he has practiced for over 25 years. 

Dr Pattison has a very busy clinical practice and alongside receiving impressive reviews from his patients, he is noted for his involvement as a principal investigator in clinical trials. These study new immunosuppressive agents used in kidney transplantation treatment.        

Dr Pattison has an impressive educational history, qualifying from Oxford University in 1987. He went on to undergo higher training in renal medicine, both nationally at Guy’s Hospital, and internationally at Stanford University in California, USA.

Dr Pattison is also a respected name in medical academia. He has authored two books, written several book chapters and co-authored several publications, mainly in the field of kidney transplantation. His work also has also been widely published in peer-reviewed journals.   

Furthermore, Dr Pattison is an active member of various professional bodies including the Royal College of Physicians (RCP), The UK Kidney Association (UKKA) and the British Transplantation Society (BTS) alongside The Medico-Legal Society. 

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