Treatment Pathway
Treatment of Glomerulonephritis
Glomerulonephritis is inflammation of the glomeruli causing hematuria, proteinuria, hypertension, and impaired kidney function. It can be acute (post-streptococcal) or chronic; IgA nephropathy is the most common form worldwide.
KDIGO (Kidney Disease Improving Global Outcomes)ERA (European Renal Association)AUA (American Urological Association)NICEEAU (Urological)
Managing Glomerulonephritis effectively requires a combination of medical treatment, lifestyle modification, and regular monitoring. With a structured management plan, most people with Glomerulonephritis can maintain a good quality of life and prevent serious complications.
First-Line Treatment Principles
- ✓BP control: target <130/80 mmHg; ACE inhibitor or ARB for proteinuric CKD
- ✓SGLT2 inhibitors for CKD with proteinuria (regardless of diabetes): reduce CKD progression by 30–40%
- ✓Treat underlying cause: immunosuppression for glomerulonephritis, antiviral for viral-associated nephropathy
- ✓Fluid management: adequate hydration in AKI; fluid restriction in oliguric/ESRD patients
- ✓Treat complications: anaemia (EPO/iron), bone disease (phosphate binders, vitamin D), hyperkalaemia
What to Do Now
- Learn your personal risk factors for Glomerulonephritis (family history, age, lifestyle)
- Attend regular health check-ups and screening tests appropriate for your age and risk
- Track new or changing symptoms, especially those associated with Glomerulonephritis
- Use our AI symptom checker to assess whether your symptoms fit an early Glomerulonephritis pattern
- Discuss preventive strategies and early monitoring with your GP
- Build a personalised management plan with your GP or specialist
- Adhere consistently to prescribed medications — do not stop without medical advice
- Adopt a Glomerulonephritis-appropriate diet (anti-inflammatory, low-glycaemic, or disease-specific)
Non-Pharmacological Management
- •Dietary protein restriction (0.6–0.8 g/kg/day) in advanced CKD to slow progression
- •Sodium restriction (<2g/day) for BP and fluid management
- •Potassium restriction in hyperkalaemia; phosphate restriction in ESRD
- •Fluid management: adequate intake in early CKD; restrict to 1.0–1.5L/day in oliguric ESRD
- •Smoking cessation: accelerates CKD progression
- •Weight management: obesity drives glomerular hyperfiltration and proteinuria
- •Regular aerobic exercise where tolerated; renal rehabilitation programmes
Treatment Goals
🎯Slow CKD progression: halve rate of GFR decline; delay dialysis/transplant
🎯UACR <30 mg/mmol (or >50% reduction from baseline)
🎯BP <130/80 mmHg; haemoglobin 100–120 g/L
🎯Preserve quality of life; minimise uraemic symptoms
🎯Renal replacement therapy (dialysis or transplant) when eGFR <10–15 and uraemic symptoms present
Monitoring Parameters
- ◆eGFR and creatinine: 3–6 monthly in CKD stages 3–4; monthly in CKD stage 5 or rapid progressors
- ◆Urine albumin-creatinine ratio (UACR): every 3–6 months
- ◆Electrolytes: potassium (ACE inhibitor/ARB risk), sodium, bicarbonate, phosphate — 3–6 monthly
- ◆FBC: haemoglobin target 100–120 g/L with EPO therapy
- ◆Parathyroid hormone (PTH), calcium, phosphate: for renal bone disease monitoring
- ◆BP: target at every visit
Red Flags — When to Escalate
- ⚠Any of the characteristic symptoms of Glomerulonephritis — even mild — in a high-risk individual
- ⚠Progressive worsening of early warning signs over weeks
- ⚠Laboratory abnormalities (e.g., blood sugar, inflammatory markers) without full symptoms
- ⚠Unexplained weight loss, night sweats, or fatigue persisting >2 weeks
- ⚠Strong family history of Glomerulonephritis combined with new relevant symptoms
- ⚠Sudden worsening of Glomerulonephritis symptoms despite established treatment
Escalation Criteria
- →AKI: urgent assessment for reversible causes; IV fluids if pre-renal; emergency dialysis if urea >35, K+>6.5, acidosis, or fluid overload
- →Rapidly progressive GFR decline → renal biopsy and specialist nephrology review
- →Hyperkalaemia >6.5 mmol/L: immediate cardiac monitoring, calcium gluconate IV, insulin-dextrose, dialysis if refractory
- →Prepare for renal replacement therapy (RRT) education when eGFR <20: home dialysis or transplant listing
Special Populations
Elderly: reduced renal reserve; drug dosing adjustment essential; less aggressive BP targets to avoid AKI
Diabetes: combination of ACE inhibitor + SGLT2i provides maximal nephroprotection
Pregnancy: pre-existing CKD significantly increases maternal and fetal risks; specialist obstetric nephrology essential
Transplant recipients: immunosuppression (calcineurin inhibitors, steroids, MMF); vigilance for opportunistic infections
Clinical Insights
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