Glomerulonephritis

What is Glomerulonephritis?

Glomerulonephritis is a group of immune-related kidney disorders in which the glomeruli, the filtration units of the kidney, become inflamed.^{[1, 2]} It is not one disease. It includes post-infectious forms, IgA nephropathy, lupus nephritis, vasculitis-related forms and anti-GBM disease, among others.^[2]

Glomerulonephritis needs a physician's diagnosis and, usually, a nephrologist's care. Some forms can damage the kidneys quickly, while others are slow and silent.

Common symptoms

Glomerulonephritis typically shows up as blood and protein in the urine, high blood pressure and reduced kidney function to a varying degree.^[2] People may notice pink or cola-colored urine, foamy urine, swelling of the face, ankles or legs, and tiredness.

Many people have no obvious symptoms and are found to have blood or protein in the urine on a routine test.^[2] A sudden, severe presentation with a nephritic picture or rapidly progressive disease is less common and is mostly seen in post-infectious disease, ANCA vasculitis and anti-GBM disease.^[2]

Causes and risk factors

Researchers group glomerulonephritis by how the immune system causes injury: infection-related, autoimmune, alloimmune, autoinflammatory and linked to abnormal antibody-producing cells.^[1] In practice, causes include infections such as streptococcal infection, hepatitis C and staphylococcal infection, systemic autoimmune disease such as lupus, and vasculitis.^{[2, 3]}

ANCA vasculitis, which often affects people over 50, is another important cause and can cause rapidly worsening kidney disease.^[4]

How it is diagnosed and treated conventionally

A kidney biopsy is the gold standard for diagnosis, and urine and blood tests, along with imaging, help find the cause.^[2] Treatment depends on the cause. Infection-related forms are mainly managed with supportive care and treatment of the infection, and post-streptococcal disease is usually self-limiting with a good outlook.^[3] Autoimmune forms are treated by suppressing the immune system, and other types need targeted therapy.^[1]

International guidelines set out recommendations for each type, including IgA nephropathy, membranous nephropathy, nephrotic syndrome, lupus nephritis, vasculitis and anti-GBM disease.^[5] In IgA nephropathy, the ACE inhibitors and ARBs used to control blood pressure and protein loss serve as the standard treatment that newer approaches are compared against.^[6] Severe disease may require dialysis.

Why Glomerulonephritis calls for a whole-person approach

Glomerulonephritis is driven by immune injury to the kidney, but people live with it day to day through symptoms, medicine side effects and worry about the kidneys. Supportive care looks at those parts, and leaves the disease and its treatment to your physicians.

The factors below are the ones where research gives some footing.

Immune activity and the cause behind it

Immune mechanisms differ greatly between types, so the cause has to be identified before treatment is chosen.^[1] This is the main reason complementary care cannot be applied to "glomerulonephritis" in general.

Infections

Infections can trigger some forms, and people on immune-suppressing treatment need to take infections seriously.^{[3, 7]}

Kidney function and symptoms

When kidney function is reduced, fatigue, poor sleep, low mood and itching are common, particularly in people on dialysis.^[8]

Treatment side effects

Immune-suppressing treatment helps control the disease but can bring adverse effects, which is one reason people look for gentler supportive options.^[7]

Acupuncture as supportive care in Glomerulonephritis

What the research shows

We did not find clinical trials of acupuncture for glomerulonephritis as a disease. The research covers chronic kidney disease more broadly, and these trials include people with many kidney conditions.

A Cochrane review of 24 trials in 1,787 adults with chronic kidney disease found only very low-quality evidence. Acupressure may have reduced fatigue, depression and sleep problems in the short term in people on hemodialysis, but high risk of bias made the estimates uncertain.^[8] A smaller review of nine studies reported better quality of life, sleep and fatigue, with no change in creatinine or filtration rate.^[9] A meta-analysis of seven trials (504 patients) found acupuncture more effective than conventional treatment for the itching that affects people on dialysis.^[10]

A review of 23 trials of moxibustion, a warming technique using burning mugwort, added to standard care in chronic kidney disease reported lower creatinine and urine protein and better quality of life. It found no effect on filtration rate, and the studies carried a moderate to high risk of bias with large differences between them.^[11]

How acupuncture may work

How acupuncture might help kidney symptoms is not established by these reviews, and we do not describe any mechanism as proven. The studies measured symptoms and laboratory values rather than testing a mechanism.^{[8, 11]}

What treatment involves

Treatment uses fine, sterile, single-use needles, usually left in place for about 20 to 40 minutes, with a short course of visits and reassessment. In prospective studies, about 9 in 100 patients had a minor reaction such as soreness or bleeding at a needle site, and serious events occurred in about 1 in 10,000 patients.^[12]

Tell the practitioner first if you have a bleeding disorder, take blood thinners, take immune-suppressing medicines, are pregnant, have a dialysis fistula or graft (needles are kept away from that arm), or have a pacemaker if electroacupuncture is considered.

Ayurvedic medicine as supportive care in Glomerulonephritis

The Ayurvedic view

Ayurveda has no classical diagnosis that matches glomerulonephritis. Practitioners may describe kidney and urinary problems as disturbance of the channels that carry urine and body fluids, and swelling as retained fluid. These are traditional frameworks and not a biomedical explanation.

Therapies that may be used

For someone under specialist care, Ayurvedic support is gentle and individual:

• Meals and daily routine that suit the person, built around any diet your nephrologist or dietitian has set
• Warm oil massage and relaxation practices for stress and sleep
• Herbs, only if your kidney team agrees, individually chosen and checked against your medicines

Panchakarma is not appropriate during active kidney inflammation, reduced kidney function, acute illness, frailty or pregnancy, or while on strong immune-suppressing treatment.

What the research shows

No trials of Ayurvedic medicine for glomerulonephritis were found. A systematic review of 33 randomized trials of traditional Chinese medicine, Ayurveda and other systems in chronic kidney disease found that Ayurveda had been tested in six. Across all 33 trials, most enrolled fewer than 100 people, and the authors called for larger studies.^[13] That evidence is for chronic kidney disease in general, and it is unclear whether it applies to glomerulonephritis.

About one fifth of Ayurvedic medicines bought online contained detectable lead, mercury or arsenic in one study, and products made with metals and minerals had the highest rates.^[14] Metals are a special concern when the kidneys are already injured.

Herbal medicine as supportive care in Glomerulonephritis

Herbs and formulas that have been studied

Most of the research is on Chinese herbal medicine for specific types of glomerular disease, mainly in China. Studied examples include Huangqi (astragalus) formulas for nephrotic syndrome and Tripterygium wilfordii (thunder god vine) extracts for nephrotic syndrome and IgA nephropathy.^{[7, 15, 16]} Traditional Chinese medicine added to standard treatment has also been studied in membranous nephropathy and IgA nephropathy.^{[6, 17]}

What the research shows

The evidence is limited, mostly from small or lower-quality trials. A Cochrane review of Huangqi-type formulas in nephrotic syndrome (nine trials) found higher blood albumin and lower urine albumin, cholesterol and triglycerides. Remission rates did not differ significantly, and the trials were small.^[7]

A meta-analysis of 29 trials in membranous nephropathy found that Chinese medicine added to standard or immune-suppressing treatment improved response rates compared with those treatments alone, and called for large, high-quality trials.^[17] A network meta-analysis of 72 trials in IgA nephropathy found Chinese medicine combined with ACE inhibitors or ARBs reduced urine protein and creatinine more than ACE inhibitors or ARBs alone.^[6] These are not comparisons with a placebo.

A Cochrane review of Tripterygium wilfordii in nephrotic syndrome (10 studies) found it may add to remission, but the evidence was weak.^[15] A meta-analysis in IgA nephropathy found a higher adverse reaction rate when it was added to ACE inhibitors or ARBs.^[16]

Safety and herb-drug interactions

Herbs can harm the kidneys. Aristolochic acid and some plant alkaloids are known kidney toxins, and contamination, adulteration and incorrect processing add to the risk.^[18] Some herbs can raise potassium, which matters when kidney function is reduced.^[19]

Tripterygium wilfordii has reported toxicity in some preparations, and the Cochrane reviewers included only two standardized extracts for that reason.^[15] It should only be taken under a nephrologist's direction.

Herbs can also interact with the medicines used for glomerulonephritis. St John's wort, for example, lowered blood levels of cyclosporine and tacrolimus, and some herbs increase bleeding with warfarin.^[20] No one with a kidney disease should start any herb or supplement without approval from their nephrologist or pharmacist. Tell us if you are pregnant or breastfeeding, or have kidney or liver disease.

Translating traditional medicine into modern biological language

This is interpretation, not equivalence. Chinese medicine may describe kidney disease with swelling and blood in the urine as spleen and kidney deficiency with dampness or heat, and Ayurveda describes disturbed fluid channels. Researchers instead study immune-mediated inflammation, protein leakage across the filter, blood pressure and fibrosis.^{[1, 13]}

Some Chinese herbal studies measure urine protein and creatinine as outcomes, which is a way of testing these ideas in modern terms. No study has shown that a traditional pattern corresponds to a specific type of glomerulonephritis.^[6]

How this care fits with your medical care

Supportive care here is complementary only. Keep your nephrologist and the rest of your treating team, take your prescribed medicines as directed, and do not stop or change them. For a condition like this, we ask that you are under a physician's care for it and that your treating team knows you are receiving complementary care.

We do not diagnose or manage glomerulonephritis. Please bring your diagnosis and biopsy result if you have one, recent kidney function and urine test results, a list of all medicines and supplements, and the details of any dialysis access.

When to seek urgent medical care

Some forms of glomerulonephritis can worsen rapidly, and these symptoms need prompt evaluation.^[2]

• Red, brown or cola-colored urine, or a marked drop in urine output
• Rapid swelling, weight gain or shortness of breath
• Severe or rising high blood pressure, with headache or vision changes
• Coughing up blood
• Persistent vomiting, confusion or extreme drowsiness
• Fever or signs of infection while taking immune-suppressing medicines

If any of these occur, call 911 or go to the nearest emergency department.