How to Diagnose Chronic Glomerulonephritis: A Comprehensive Medical Evaluation Guide

Understanding Chronic Glomerulonephritis and Why Early Detection Matters

Chronic glomerulonephritis (CGN) is a progressive kidney disorder characterized by persistent inflammation and damage to the glomeruli—the tiny filtering units in your kidneys. Left undiagnosed or poorly managed, CGN can gradually impair kidney function and increase long-term risks of hypertension, cardiovascular disease, and even end-stage renal disease. Recognizing early warning signs—such as unexplained swelling (especially in the face, hands, or ankles), foamy urine (indicating protein loss), visible or microscopic blood in the urine, persistent high blood pressure, or unrelenting fatigue—is the critical first step toward timely intervention.

The Essential Diagnostic Pathway: From Clinical Assessment to Confirmatory Testing

Accurate diagnosis of chronic glomerulonephritis doesn't rely on a single test—it requires a coordinated, multi-step approach guided by a board-certified nephrologist. Your evaluation begins with a thorough clinical history review and comprehensive physical examination. During this visit, your doctor will assess vital signs—including blood pressure—and look for telltale physical clues like periorbital edema (swelling around the eyes), pitting edema in the lower extremities, or signs of fluid retention. These findings help determine whether further targeted testing is warranted.

Urinalysis: The First-Line Screening Tool

Urinalysis remains the cornerstone of initial screening. In patients with CGN, abnormal urinary findings are nearly universal. You may see:

Proteinuria: Typically ranging from 1–3 grams per day—often detected via dipstick testing and quantified with a 24-hour urine collection or urine protein-to-creatinine ratio (UPCR).
Hematuria: Microscopic blood in urine is common; about 10–15% of individuals may experience gross hematuria—visible pink, red, or cola-colored urine—especially during upper respiratory infections or periods of physical stress.
Urinary sediment abnormalities: Microscopic examination often reveals granular casts and hyaline casts, which reflect ongoing glomerular injury and tubular dysfunction.

Consistent abnormalities across multiple urinalyses significantly raise suspicion for underlying glomerular disease.

Blood Tests: Assessing Kidney Function and Systemic Impact

Blood work provides vital insights into how well your kidneys are filtering waste and whether systemic complications are emerging. Key markers include:

Serum creatinine and estimated glomerular filtration rate (eGFR): While eGFR may remain normal in early-stage CGN, rising creatinine levels or a declining eGFR over time signals progressive functional loss.
Blood urea nitrogen (BUN): Elevated BUN—particularly when paired with elevated creatinine—suggests worsening filtration capacity.
Electrolytes, albumin, and complement levels: Low serum albumin points to significant protein loss; abnormal C3/C4 complement levels may hint at immune-mediated causes like lupus nephritis or post-infectious GN.

Importantly, normal blood test results do not rule out early chronic glomerulonephritis—which underscores why clinical context and serial monitoring are essential.

Kidney Biopsy: The Gold Standard for Definitive Diagnosis

When non-invasive tests suggest CGN—or when treatment decisions hinge on precise disease classification—a percutaneous kidney biopsy is considered the diagnostic gold standard. Performed under ultrasound guidance by experienced interventional nephrologists, this minimally invasive procedure collects small tissue samples for light microscopy, immunofluorescence, and electron microscopy analysis. It enables accurate differentiation between subtypes—including IgA nephropathy, membranous nephropathy, focal segmental glomerulosclerosis (FSGS), and lupus nephritis—each requiring distinct management strategies.

Who Is a Candidate for Biopsy—and When Is It Not Recommended?

Biopsy isn't appropriate for everyone. Contraindications include uncontrolled hypertension, severe bleeding disorders, solitary kidney, or advanced chronic kidney disease (eGFR <15 mL/min) where findings would not alter clinical management. Your nephrologist will carefully weigh risks versus benefits—considering your age, comorbidities, and overall prognosis—before recommending this step.

Why Partnering With a Nephrology Specialist Makes All the Difference

Diagnosing chronic glomerulonephritis demands expertise beyond routine primary care. A specialized nephrology team brings deep knowledge of rare kidney diseases, access to advanced lab assays (like anti-PLA2R antibodies for membranous nephropathy), and experience interpreting complex histopathology reports. Early referral—especially after persistent proteinuria (>0.5 g/day) or hematuria lasting more than 3 months—improves long-term outcomes, preserves kidney function, and helps personalize lifestyle, dietary, and pharmacologic interventions.

Next Steps: Proactive Monitoring and Prevention

Even after diagnosis, CGN management is dynamic. Regular follow-up—including quarterly urinalysis, biannual bloodwork, annual eGFR tracking, and home blood pressure monitoring—empowers both patient and provider to detect subtle changes early. Lifestyle modifications such as low-sodium diets, smoking cessation, strict blood pressure control (<130/80 mmHg), and avoiding NSAIDs play a proven role in slowing progression. With today's precision diagnostics and evidence-based therapies, many people with chronic glomerulonephritis live full, active lives for decades—making timely, accurate diagnosis more important than ever.