Glomerulonephritis
"In glomerulonephritis, continued medical monitoring and early detection are critical to preserve kidney function and avoid long-term complications."
DR. JOSÉ MARÍA MORA GUTIÉRREZ
SPECIALIST. NEPHROLOGY DEPARTMENT
What is glomerulonephritis?
Glomerulonephritis (or glomerular nephropathy) is a kidney disease in which the structure and function of the glomerulus—the filtration unit of the kidney responsible for removing waste from the body—are altered. This damage can progress over time and compromise kidney function in the long term.
There are primary forms (limited to the kidney) and secondary forms (associated with systemic diseases such as systemic lupus erythematosus, vasculitis, infections, or certain medications). It may present as either an acute or chronic condition.
At the Department of Nephrology of the Clínica Universidad de Navarra, we perform an early and accurate diagnosis to determine the most appropriate and personalized treatment.
Although glomerulonephritis can progress to chronic kidney failure, the prognosis is generally favorable when medical recommendations are followed, improving both the course of the disease and the patient’s quality of life.
What are the symptoms of glomerulonephritis?
Glomerulonephritis may go unnoticed or present with clear signs. These are the key symptoms that should be recognized promptly.
- Changes in urine: decreased urine output (oliguria) or complete absence of urine (anuria), as well as changes in color — it may become reddish or dark brown due to the presence of blood (hematuria).
- Fluid retention: leads to swelling (edema) in the legs, ankles, and face, and may contribute to high blood pressure and, in severe cases, heart failure.
- Nephrotic syndrome: occurs when there is excessive protein loss in the urine, leading to decreased protein levels in the blood. This causes more generalized swelling (edema) and triggers a liver response that increases lipid production, raising cholesterol levels.
- General symptoms: include fatigue, pale skin and mucous membranes, headaches, tiredness, and, in some cases, shortness of breath due to fluid overload in the body.
Do you have any of these symptoms?
If you suspect that you have any of the above symptoms,
you should consult a medical specialist for a diagnosis.
What causes glomerulonephritis?
Most cases of glomerulonephritis have an immunological origin. When the immune system reacts abnormally, it attacks the structures of the kidney and damages the glomeruli—the filters responsible for cleansing the blood. Depending on the mechanism of injury, several main types can be distinguished:
- Direct immune injury: T lymphocytes attack the kidney’s basement membrane, as seen in minimal change glomerulonephritis.
- Formation of immune complexes: the body produces antibodies that bind to kidney proteins, causing inflammation in the glomeruli. This mechanism is typical of proliferative glomerulonephritis, such as extracapillary forms.
- Deposition of antigens and antibodies: foreign antigens—of infectious or tumor origin—may deposit in the glomeruli and trigger an immune response that leads to renal inflammation.
Types of glomerulonephritis
Treatment and prognosis depend on the specific type. A kidney biopsy is the definitive test for diagnosis.
Primary forms
- Membranous nephropathy: thickening of the capillary walls; the most common cause of nephrotic syndrome in non-diabetic adults over 40 years of age.
- IgA nephropathy: the most frequent form worldwide; usually follows a slow progression and is a significant cause of chronic kidney disease (CKD).
- Focal segmental glomerulosclerosis (FSGS) and minimal change disease (MCD): marked proteinuria with variable course and therapeutic response.
Secondary forms
- Lupus nephritis: a severe manifestation of systemic lupus erythematosus (SLE); up to 50% of adults with lupus may develop it.
- Immune complex and complement-mediated GN: glomerular inflammation caused by antibodies and complement activation.
- Infection-related GN: bacterial (e.g., postinfectious, associated with endocarditis or shunts) or viral (HIV, HBV, HCV) infections can cause GN.
- Rapidly progressive glomerulonephritis (RPGN): a clinical syndrome with kidney function deterioration over days or weeks, occurring in various immune-mediated contexts.
How are glomerulonephritis diagnosed?
Diagnosis of glomerulonephritis requires a thorough clinical evaluation along with detailed laboratory and imaging studies. The initial steps include a urinalysis (to detect protein and blood), blood tests (to assess kidney function and immune markers), and imaging tests such as a renal ultrasound. However, the definitive diagnosis is made through a kidney biopsy, which allows direct microscopic examination of the glomerular tissue.
At the Department of Nephrology of the Clínica Universidad de Navarra, this procedure is performed with high-precision techniques under ultrasound guidance, ensuring maximum patient safety and expert histological interpretation to determine the exact type of glomerulonephritis and guide the most appropriate treatment.
Early diagnosis is essential to initiate treatment promptly and prevent the progression of glomerulonephritis to chronic kidney disease.
How are glomerulonephritis treated?
Treatment of glomerulonephritis is complex and highly individualized, as it must be tailored to the specific type, degree of renal damage and risk of progression that is present
Supportive and renoprotective measures
These measures are essential to preserve long-term kidney function, regardless of the type of glomerulonephritis.
- Blood pressure and proteinuria control: the first line of treatment. The use of angiotensin-converting enzyme inhibitors (ACEIs) or angiotensin II receptor blockers (ARBs) at the maximum tolerated dose is recommended, with the goal of reducing proteinuria below 0.7 g/24 h or achieving complete remission (<0.5 g/24 h).
- Diet and lifestyle: limit sodium intake (ideally <2 g/day) to control blood pressure and edema. Encourage regular physical activity and manage hyperlipidemia (cholesterol) with medications such as statins, especially in patients with lupus nephritis due to their high cardiovascular risk.
- Prophylactic anticoagulation: consider the use of aspirin or warfarin in cases of membranous nephropathy with hypoalbuminemia (low serum albumin levels) to prevent venous or arterial thrombosis.
- Hydroxychloroquine (HCQ): recommended for all patients with lupus nephritis, unless contraindicated. It reduces lupus flares and improves both renal and overall survival.
Pharmacological treatment
The pharmacological treatment of glomerulonephritis aims to modulate or suppress the autoimmune response that causes damage to the glomeruli. The choice of medication or combination depends on the histological type (determined by kidney biopsy) and the clinical severity of the disease.
- Glucocorticoids: these form the cornerstone of active treatment in most cases of glomerulonephritis due to their anti-inflammatory and immunosuppressive effects. In severe cases, intravenous pulses of methylprednisolone are administered, followed by oral doses that are gradually reduced to minimize side effects from prolonged use.
- Cytotoxic and steroid-sparing agents: cyclophosphamide is reserved for aggressive forms such as proliferative lupus nephritis or rapidly progressive GN. Mycophenolate mofetil (MMF) and its analogs are widely used for their efficacy and better tolerability, especially for maintaining remission. Azathioprine is a safe alternative during pregnancy or in patients who cannot tolerate MMF.
- Calcineurin inhibitors: including cyclosporine, tacrolimus, and voclosporine. They are used in various types of GN, such as membranous glomerulonephritis or steroid-resistant focal segmental glomerulosclerosis. In addition to their immunosuppressive action, they help reduce proteinuria, although close monitoring is required due to potential renal toxicity.
- Biologic therapies: drugs such as rituximab (an anti-CD20 antibody) selectively deplete B lymphocytes and have proven effective in membranous glomerulonephritis and refractory lupus nephritis. Belimumab, approved for active lupus nephritis, is added to standard therapy to improve response and reduce relapses.
- Complement inhibitors: represent emerging therapies, such as avacopan (a C5a inhibitor), which are useful in severe forms like rapidly progressive GN or C3 glomerulopathy, targeting specific immune pathways involved in the disease.
At the Department of Nephrology of the Clínica Universidad de Navarra, treatment is tailored to each patient, combining efficacy and safety to achieve clinical remission and preserve kidney function in the long term.
What clinical trials do we have on glomerulonefritis?
Where do we treat it?
IN NAVARRE AND MADRID
The Nephrology Service
of the Clínica Universidad de Navarra
The Nephrology Service of the Clínica Universidad de Navarra has more than five decades of experience, both in the diagnosis and treatment of all kidney pathologies and in the transplant of this organ.
Our specialists have completed their training in centers of national and international reference.
We have the best facilities in the Dialysis Unit in order to offer the highest quality care to our patients.
Diseases we treat
- Edemas and internal environment
- Kidney function studies
- Glomerulonephritis
- Arterial hypertension
- Acute kidney failure
- Chronic renal failure
- Use of diuretics
Why at the Clinica?
- National reference in kidney transplantation, pioneer in living donor kidney transplantation.
- Specialized nursing for the care and follow-up of our patients.
- Cardiovascular and renal damage prevention program.
Our team of professionals
