Understanding Chronic Glomerulonephritis: Causes, Symptoms, Diagnosis, and Modern Management Strategies

Chronic glomerulonephritis (CGN) isn't a single disease—it's an umbrella term for a diverse group of progressive kidney disorders primarily affecting the glomeruli, the tiny filtering units within the kidneys. Unlike acute kidney conditions that present with sudden, dramatic symptoms, CGN typically develops silently over months or even years. Many individuals remain asymptomatic until routine health screenings—such as urinalysis or blood tests—reveal early warning signs like persistent proteinuria (excess protein in urine) or microscopic hematuria (red blood cells in urine).

What Are the Key Clinical Features?

While symptoms vary significantly depending on the underlying pathology, the classic quartet associated with advancing CGN includes: proteinuria, hematuria, hypertension, and edema (swelling)—often in the legs, ankles, face, or hands. Importantly, these signs rarely appear simultaneously. For instance, a patient might first notice foamy urine due to protein loss, followed months or years later by elevated blood pressure or unexplained weight gain from fluid retention. This delayed and variable presentation is why CGN is often dubbed a "silent epidemic" among adults aged 30–60.

Diagnostic Criteria & Clinical Thresholds

In clinical practice, chronic glomerulonephritis is generally diagnosed when 24-hour urinary protein excretion exceeds 1 gram, especially if accompanied by persistent hematuria and/or evidence of declining kidney function (e.g., rising serum creatinine or reduced estimated glomerular filtration rate [eGFR]). Notably, some patients may meet diagnostic criteria even before measurable renal impairment occurs—highlighting the importance of proactive monitoring in high-risk groups, including those with autoimmune conditions, recurrent infections, or family history of kidney disease.

Why Accurate Subtyping Is Critical

Under the broad CGN label lie distinct pathological entities—including IgA nephropathy, membranous nephropathy, focal segmental glomerulosclerosis (FSGS), and lupus nephritis—each with unique mechanisms, prognoses, and treatment pathways. Renal biopsy remains the gold standard for definitive classification. We strongly recommend biopsy for eligible patients with sustained proteinuria >1 g/day before significant eGFR decline occurs. Early histological diagnosis enables precision medicine approaches—such as targeted immunosuppression, RAAS blockade optimization, or emerging therapies like SGLT2 inhibitors and endothelin receptor antagonists—that can dramatically slow progression and preserve long-term kidney health.

Proactive Care Beyond Medication

Effective management extends far beyond pharmacotherapy. Lifestyle interventions play a pivotal role: strict blood pressure control (<130/80 mmHg), low-sodium (<2 g/day) and moderate-protein (<0.8 g/kg/day) diets, smoking cessation, regular aerobic activity, and vigilant monitoring of cardiovascular risk factors. Emerging research also underscores the value of patient education, shared decision-making, and multidisciplinary care involving nephrologists, dietitians, pharmacists, and mental health professionals—especially given the psychosocial burden of a chronic, invisible illness.

Looking Ahead: Hope in Early Intervention

With earlier detection, refined diagnostics, and increasingly personalized treatment protocols, the outlook for people living with chronic glomerulonephritis has improved markedly. Today, many patients maintain stable kidney function for decades—avoiding dialysis or transplantation altogether. The key lies not in waiting for symptoms to escalate, but in recognizing subtle red flags, seeking expert evaluation promptly, and embracing a holistic, evidence-based approach to lifelong kidney wellness.