Effective Treatment Strategies for Chronic Glomerulonephritis: A Comprehensive, Evidence-Based Approach

Chronic glomerulonephritis (CGN) is a progressive kidney disorder characterized by persistent inflammation of the glomeruli—the tiny filtering units in the kidneys. Left unmanaged, it can lead to declining renal function, proteinuria, hypertension, and eventually chronic kidney disease (CKD) or end-stage renal disease (ESRD). Fortunately, modern nephrology offers a multifaceted, individualized treatment strategy that targets underlying inflammation, reduces protein leakage, controls blood pressure, mitigates oxidative stress, and preserves long-term kidney health.

First-Line Medications to Reduce Proteinuria and Protect Renal Function

Angiotensin II receptor blockers (ARBs)—such as valsartan—and angiotensin-converting enzyme inhibitors (ACEIs)—like benazepril—are cornerstone therapies for CGN. These medications not only lower systemic blood pressure but also exert critical intraglomerular hemodynamic effects: they dilate efferent arterioles, reduce intraglomerular capillary pressure, and thereby significantly decrease urinary protein excretion. Clinical trials consistently demonstrate that early and sustained use of ARBs or ACEIs slows the decline in estimated glomerular filtration rate (eGFR) and delays CKD progression.

For patients with moderate-to-severe proteinuria (urinary protein >1.5 g/24 hours), short-term low-to-moderate dose corticosteroid therapy—typically oral prednisone—may be added under close specialist supervision. This immunomodulatory approach helps suppress immune-mediated glomerular injury, especially in histologically confirmed forms like IgA nephropathy or membranous nephropathy. Treatment duration is carefully titrated (often 6–12 weeks) to balance efficacy with minimizing steroid-related side effects such as hyperglycemia, osteoporosis, or infection risk.

Adjunctive Therapies to Support Kidney Health and Reduce Oxidative Stress

Dipyridamole, an antiplatelet agent with additional vasodilatory and antioxidant properties, plays a valuable supportive role. By inhibiting platelet aggregation and improving microcirculation within the renal cortex, it helps prevent microthrombosis and ischemic damage in inflamed glomeruli—particularly beneficial in patients with elevated plasma viscosity or coexisting cardiovascular risk factors.

Nephroprotective herbal-derived supplements—including Jinshuibao capsules (fermented Cordyceps sinensis) and Bailing capsules (mycelium of Paecilomyces hepiali)—are widely used in integrative nephrology practice. While not substitutes for evidence-based pharmacotherapy, robust clinical data suggest these agents may help stabilize renal function by reducing tubulointerstitial fibrosis, lowering inflammatory cytokines (e.g., TGF-β, IL-6), and enhancing mitochondrial energy metabolism in renal tubular cells. Always consult a healthcare provider before combining them with prescription medications to avoid potential herb-drug interactions.

Optimizing Blood Pressure Control for Renal Protection

Hypertension is both a common consequence and a major accelerator of CGN progression. Beyond ARBs and ACEIs, calcium channel blockers (CCBs)—including nifedipine (extended-release formulations) and amlodipine besylate—offer synergistic antihypertensive benefits without compromising renal perfusion. Their ability to relax vascular smooth muscle improves systemic and renal arterial compliance, further reducing glomerular hyperfiltration and mechanical stress on podocytes.

A target blood pressure of <130/80 mmHg is generally recommended for adults with CGN and proteinuria—a stricter goal than standard hypertension guidelines—to maximize renoprotection. Home blood pressure monitoring and regular ambulatory BP assessment are strongly encouraged to ensure consistent control throughout the day and night.

Managing Fluid Retention and Edema

When fluid overload develops—manifesting as peripheral edema, pulmonary congestion, or weight gain—diuretic therapy becomes essential. Thiazide diuretics (e.g., hydrochlorothiazide) are effective for mild edema, while loop diuretics like furosemide are preferred in moderate-to-severe cases or when glomerular filtration is reduced (eGFR <60 mL/min/1.73m²). To enhance efficacy and minimize electrolyte disturbances, diuretics are often combined with low-sodium dietary counseling (<2 g/day sodium) and monitored via serum electrolytes, creatinine, and body weight trends.

Importantly, successful CGN management extends beyond medication—it requires a holistic lifestyle foundation: smoking cessation, plant-predominant nutrition, regular physical activity, glycemic control (if diabetic), and avoidance of nephrotoxic agents (e.g., NSAIDs, excessive contrast dye). Partnering with a board-certified nephrologist and engaging in shared decision-making ensures timely interventions, personalized adjustments, and optimal long-term outcomes.