Effective Treatment Strategies for Chronic Glomerulonephritis: Evidence-Based Approaches for Kidney Protection and Disease Management

Why Accurate Diagnosis Is the First Step in Managing Chronic Glomerulonephritis

Chronic glomerulonephritis (CGN) is a progressive, immune-mediated kidney disorder that often develops silently—many patients remain asymptomatic until significant renal function is lost. To design an effective, personalized treatment plan, renal biopsy remains the gold standard diagnostic tool. This minimally invasive procedure enables pathologists to identify the precise histological subtype—such as IgA nephropathy, membranous nephropathy, focal segmental glomerulosclerosis (FSGS), or lupus nephritis—which directly determines prognosis and therapeutic response.

Tailored Medical Therapy Based on Histopathology

Once the pathological classification is confirmed, clinicians can implement targeted interventions:

Hormonal and Immunosuppressive Regimens

For proliferative or crescentic forms of CGN, corticosteroids (e.g., prednisone) are frequently combined with immunosuppressants such as mycophenolate mofetil, cyclophosphamide, or rituximab. These agents suppress aberrant immune activity, reduce glomerular inflammation, and slow the decline in estimated glomerular filtration rate (eGFR).

Supportive and Symptom-Oriented Care

Alongside disease-modifying therapy, comprehensive management includes strict blood pressure control (target <130/80 mmHg), dietary sodium restriction (<500–1500 mg/day), protein moderation (0.8 g/kg/day for non-dialysis patients), lipid management, and smoking cessation—all proven to delay progression to end-stage kidney disease (ESKD).

Non-Biopsy Management: When Renal Biopsy Isn't Feasible

In cases where biopsy is contraindicated or declined, clinicians rely on clinical biomarkers—including 24-hour urine protein quantification, serum creatinine, eGFR trends, and urinalysis—to guide conservative therapy. The primary therapeutic goal becomes proteinuria reduction, since persistent heavy proteinuria (>1 g/day) independently predicts faster renal deterioration.

First-Line Antiproteinuric Agents: ACE Inhibitors & ARBs

ACE inhibitors (e.g., lisinopril, ramipril) and angiotensin II receptor blockers (ARBs; e.g., losartan, valsartan) are cornerstone therapies—not only for hypertension control but also for their well-documented renoprotective effects. They dilate efferent arterioles, lower intraglomerular pressure, and stabilize the podocyte filtration barrier. Clinical guidelines recommend titrating doses to the highest tolerated level—even in normotensive patients—as long as serum potassium remains <5.0 mmol/L and eGFR doesn't drop >30% acutely.

Complementary and Adjunctive Options

While evidence varies in strength, certain adjunctive approaches show promise in select populations: SGLT2 inhibitors (e.g., dapagliflozin) now have FDA/EMA approval for chronic kidney disease regardless of diabetes status, offering robust antiproteinuric and cardio-renal benefits. Some integrative strategies—like fish oil supplementation in IgA nephropathy or vitamin D analogs in secondary hyperparathyroidism—may be considered under specialist supervision. However, traditional herbal preparations (e.g., cordyceps or blood-activating formulas) lack rigorous RCT validation and should never replace guideline-recommended pharmacotherapy.

Long-Term Monitoring and Proactive Prevention

Successful CGN management hinges on consistent follow-up: quarterly assessment of urine albumin-to-creatinine ratio (UACR), serum electrolytes, eGFR, and blood pressure. Early referral to a nephrologist—especially when UACR exceeds 300 mg/g or eGFR falls below 60 mL/min/1.73m²—significantly improves outcomes. With timely diagnosis, precision treatment, and patient-centered lifestyle support, many individuals with chronic glomerulonephritis maintain stable kidney function for decades.