Is One Plus Sign in Nephritis Serious?
When nephritis is diagnosed with a (+) result for either proteinuria or hematuria, it typically indicates a mild form of the condition. However, proper evaluation requires more than just these initial findings. Understanding the underlying causes and conducting further diagnostic tests are essential to determine the actual severity and appropriate treatment plan.
Understanding Hematuria in Nephritis
Hematuria, or blood in the urine, is a common sign of kidney inflammation. The presence of red blood cells alone doesn't necessarily indicate severe disease. What matters most is the shape and morphology of the red blood cells. If the majority of red blood cells appear deformed under microscopic examination, this strongly suggests that the bleeding originates from the glomeruli—pointing toward glomerulonephritis. This deformation occurs as red blood cells pass through damaged kidney filters.
On the other hand, if the red blood cells maintain a normal shape, the source of bleeding may not be the glomerulus. Instead, conditions such as urinary tract stones, infections, or even tumors could be responsible. In such cases, additional imaging studies like ultrasound or CT scans may be necessary to rule out structural abnormalities.
Evaluating Proteinuria: What Does a (+) Mean?
Protein in the urine, marked as (+), is another key indicator in nephritis. However, a single dipstick test isn't enough to assess severity. A more accurate method is the 24-hour urine protein quantification test.
Interpreting Protein Levels
If the 24-hour urine shows less than 0.5 grams of protein, it's classified as microalbuminuria, which generally reflects mild kidney involvement. At this stage, lifestyle modifications—such as reducing salt intake, managing blood pressure, and avoiding nephrotoxic substances—can help stabilize kidney function.
Levels between 0.5 to 1 gram per day are considered mild to moderate proteinuria. With proper medical supervision, including medications like ACE inhibitors or ARBs (which reduce protein leakage and protect kidney function), many patients can bring their levels back below 0.5g/day.
However, when protein excretion exceeds 1 gram per day, especially if dipstick results show (++), (+++), or even (++++), this signals more significant kidney damage. Such cases often require advanced interventions, including corticosteroids or immunosuppressive drugs like mycophenolate mofetil or cyclophosphamide, depending on the underlying type of nephritis.
Beyond Urine Tests: Assessing Overall Kidney Function
It's crucial to understand that neither proteinuria nor hematuria alone can definitively determine how serious the nephritis is. A more comprehensive picture comes from evaluating serum creatinine levels and estimating the glomerular filtration rate (eGFR).
If blood tests reveal a significantly elevated serum creatinine level, this indicates impaired kidney function. An eGFR below 60 mL/min/1.73m² over three months confirms chronic kidney disease. In acute settings, a sudden rise in creatinine may suggest rapidly progressive glomerulonephritis, which requires urgent evaluation and potentially a kidney biopsy.
Additional markers such as blood urea nitrogen (BUN), albumin levels, and autoimmune panels (like ANA, anti-dsDNA, ANCA) may also be ordered to identify secondary causes like lupus nephritis or vasculitis.
Taking the Next Steps
A (+) finding in routine urinalysis should never be ignored, but it also shouldn't cause immediate alarm. Early detection and proper management greatly improve long-term outcomes. Patients should work closely with a nephrologist to develop a personalized care plan based on clinical symptoms, lab results, and potential underlying diseases.
With timely intervention, even cases of moderate nephritis can be stabilized, preventing progression to kidney failure. Regular monitoring, medication adherence, and healthy lifestyle choices remain the cornerstone of effective kidney disease management.