ANCA titers: rising titers may precede clinical relapse by weeks
Not independently sufficient to justify treatment change
Anti-GBM antibody: must become undetectable before stopping plasma exchange
Complement levels: guide activity in lupus and complement-mediated GN
Patient Discharge Instructions
copy discharge instructions
Discharge instructions for Glomerulonephritis
What is glomerulonephritis?
GN is inflammation of the kidney filters (glomeruli), which can cause blood and protein in the urine, high blood pressure, and reduced kidney function
Many different causes exist; your doctor will explain which type you have
Some forms are mild and resolve on their own; others require specific treatment
Diet and lifestyle instructions
Limit salt (sodium) to less than 2 grams per day (no added salt, avoid processed foods)
Limit fluid intake if you have swelling or your doctor instructs you to do so
Moderate protein intake: 0.8-1.0 g per kg of your body weight per day
Avoid NSAIDs (ibuprofen, naproxen, aspirin for pain): these can worsen kidney function
Avoid dehydration: take your medications with adequate water
Weigh yourself daily: report a gain of more than 2 kg (4.4 lbs) in 48 hours to your doctor
Medications
Take all prescribed medications exactly as directed
If prescribed blood pressure medications (ACE inhibitor or ARB), do not stop without calling your doctor
If prescribed immunosuppressive medications (prednisone, mycophenolate, cyclophosphamide, rituximab), follow all monitoring instructions
Do not take any new medications including vitamins and supplements without consulting your nephrologist
Monitoring at home
Check and record blood pressure daily if a home cuff is available
Target blood pressure below 130/80 mmHg (your doctor may specify a different target)
Note changes in urine color, amount, or foaminess
Return to emergency room immediately for
Emergency symptoms requiring immediate care
Decreased or no urine output
Cola-colored or bloody urine returning or worsening
Rapid weight gain or markedly worsening leg swelling
Severe headache, vision changes, or confusion (possible hypertensive emergency)
Coughing up blood
Shortness of breath at rest or when lying flat
Fever above 38.5 C (101.3 F), especially if on immunosuppressive medications
Chest pain or racing heart
Follow-up care
Nephrology follow-up as scheduled; do not miss appointments
Bring your medication list to every appointment
Blood tests will be needed regularly to monitor kidney function and medication effects
References
Guidelines and key sources
Primary references
Sethi S, De Vriese AS, Fervenza FC. Acute Glomerulonephritis. Lancet. 2022
PubMed: 35461559
Comprehensive review of GN pathophysiology and management
KDIGO 2021 Clinical Practice Guideline for the Management of Glomerular Diseases
Kidney International 2021; comprehensive guidance for all GN subtypes
Available at: kdigo.org/wp-content/uploads/2024/05/KDIGO-2021
KDIGO 2024 Guideline for ANCA-Associated Vasculitis
Kidney International 2024
PubMed: S0085-2538(23)00744-5
Sethi S, Haas M, Markowitz GS et al. Mayo Clinic/Renal Pathology Society Consensus Report on Pathologic Classification, Diagnosis, and Reporting of GN. JASN 2016
PubMed: 26567243
Key clinical trials
RAVE trial (rituximab versus cyclophosphamide for ANCA vasculitis induction)
NEJM 2010; rituximab non-inferior at 6 months for remission
Superior in relapsing disease
PEXIVAS trial (plasma exchange in ANCA vasculitis)
NEJM 2020; plasma exchange did not reduce ESKD or death at 7 years
Reserved for dialysis-dependent or pulmonary hemorrhage
ADVOCATE trial (avacopan in ANCA vasculitis)
NEJM 2021; avacopan non-inferior to prednisolone, superior at 52 weeks
PROTECT trial (sparsentan in IgA nephropathy)
NEJM 2023; superior proteinuria reduction versus irbesartan
DAPA-CKD trial (dapagliflozin in CKD with proteinuria)
NEJM 2020; 40% reduction in progression to ESKD
NefIgArd trial (targeted-release budesonide for IgA nephropathy)
Floege J, Amann K. Primary Glomerulonephritides. Lancet 2016. PubMed: 26921911
Hricik DE, Chung-Park M, Sedor JR. Glomerulonephritis. NEJM 1998. PubMed: 9748199
Canney M et al. Cardiovascular Events in Primary Glomerular Diseases. AJKD 2022. PubMed: 35659570
Stoneman S, Teh JW, O'Shaughnessy MM. IgA Nephropathy in Adults. JAMA 2026
PubMed: 10.1001/jama.2025.25020
Dhakal AK et al. Acute Post-Streptococcal GN in Children. Nephrol Dial Transplant 2025
PubMed: 40650562
Meena J et al. AsPNA Clinical Practice Guidelines for Infection-Related GN. Pediatric Nephrology 2026
PubMed: 41627401
Tang A et al. Complement Activation in Anti-GBM Disease. Front Immunol 2023. PubMed: 37781380
Pesce F et al. Glomerulonephritis in AKI. Front Med 2021. PubMed: 33738291
SymptomDx is an educational tool for medical professionals. It does not replace clinical judgment. Verify all clinical data and drug dosages with authoritative sources.