How can I differentiate between the various types of glomerulonephritis in a primary care setting?

In a primary care setting, the definitive differentiation between various types of glomerulonephritis is generally not possible, as this typically requires specialist investigations ¹,²,³. The role of primary care is primarily to identify individuals with suspected kidney disease, including potential glomerulonephritis, and to facilitate timely referral to secondary care for diagnosis and management ¹,²,³,⁴.

Key actions in primary care include:

• Identifying Risk Factors and Symptoms: Be alert for symptoms such as oedema, macroscopic haematuria, or signs of acute kidney injury (AKI) ⁴.
• Initial Investigations: Perform a urine dipstick test for proteinuria and haematuria ¹,². Blood tests should be conducted to assess kidney function, including serum creatinine to estimate glomerular filtration rate (eGFR) ¹,²,³.
• Referral to Secondary Care: Refer patients urgently to a nephrologist if there is a rapid decline in eGFR, significant proteinuria (e.g., albumin:creatinine ratio ≥70 mg/mmol), persistent haematuria with proteinuria, or other features suggestive of progressive kidney disease ¹,²,³. Specialist evaluation is crucial for understanding specific glomerular and tubulointerstitial diseases (Beck LH Jr and Salant, 2008). Definitive diagnosis of specific glomerulonephritis types often relies on specialist procedures such as a kidney biopsy, which are not performed in primary care (Beck LH Jr and Salant, 2008).