Glomerulonephritis Symptoms
Glomerulonephritis typically presents with a combination of glomerular hematuria (often with dysmorphic red blood cells and red cell casts), proteinuria, hypertension, and reduced kidney function, though many patients may be asymptomatic in early stages 1.
Core Clinical Presentations
The clinical manifestations of glomerulonephritis fall into distinct syndromes:
Nephrotic Syndrome (Most Common)
- Proteinuria >3.5 g/day (or protein-creatinine ratio >3.5 g/g)
- Edema - present in 74.9% of cases, often the most visible symptom 2
- Hypoalbuminemia
- Hyperlipidemia
- Present in approximately 54% of glomerulonephritis cases 3
Nephritic Syndrome
- Glomerular hematuria with dysmorphic erythrocytes
- Red blood cell casts in urine sediment (pathognomonic for glomerulonephritis) 4
- Hypertension
- Oliguria
- Acute kidney injury
- More common in post-infectious GN, ANCA-associated vasculitis, and anti-GBM disease 1
Rapidly Progressive Glomerulonephritis (RPGN)
This is a nephrological emergency requiring immediate evaluation 5, 4:
- Rapid decline in kidney function over days to weeks
- Acute kidney injury present in 43.3% of biopsy cases 2
- Often accompanied by nephritic urinary sediment
- Requires urgent immunosuppression even before biopsy confirmation if clinical presentation and serology are compatible 6
Key Diagnostic Indicators
Urinary Findings (Critical for Detection)
- Glomerular hematuria - dysmorphic red blood cells visible on urine sediment 6
- Acanthocytes - highly specific for glomerular disease 4
- Red blood cell casts - diagnostic for glomerulonephritis 4
- Proteinuria >0.5 g/day - should always prompt further evaluation 5
- Pyuria without infection
Associated Findings
- Hypertension - present in 39-42.5% of cases 3, 2
- Reduced eGFR - renal failure present in 28% at presentation 3
- Edema (particularly periorbital and lower extremity)
Clinical Pitfalls
Many patients present with minimal or absent symptoms in early stages 7. This makes routine urinalysis screening critical when even minimal suspicion exists. Simple urine dipstick testing for protein and blood, combined with microscopic examination of urinary sediment, represents a highly relevant yet underutilized diagnostic tool 7.
Presentation Patterns by Type
While definitive diagnosis requires kidney biopsy 6, certain patterns emerge:
- IgA nephropathy: Often presents with episodic gross hematuria following upper respiratory infections
- Post-infectious GN: Acute nephritic syndrome 1-3 weeks after streptococcal infection
- ANCA-associated vasculitis: RPGN with systemic symptoms (fever, weight loss, pulmonary involvement)
- Membranous nephropathy: Predominantly nephrotic syndrome with gradual onset
- Minimal change disease: Sudden onset nephrotic syndrome, especially in children
When to Suspect Glomerulonephritis
Evaluate immediately for glomerulonephritis when finding:
- Proteinuria >0.5 g/day 5
- Glomerular hematuria (dysmorphic RBCs)
- Newly developed hypertension with urinary abnormalities 5
- Unexplained decline in kidney function with active urinary sediment
- Combination of edema, hypertension, and urinary abnormalities
The presence of urine acanthocytes and cellular casts are diagnostic for glomerulonephritis or vasculitis 4, and their detection should trigger urgent nephrology referral and consideration of kidney biopsy.