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

Guideline-aligned answer with reasoning, red flags and references. Clinically reviewed by Dr Kola Tytler MBBS CertHE MBA MRCGP.

Posted: 16 August 2025 Guideline-Aligned (High Confidence) Clinically Reviewed
Dr Kola Tytler MBBS CertHE MBA MRCGPClinical Lead • iatroX

In a primary care setting, the definitive differentiation between various types of glomerulonephritis is generally not possible, as this typically requires specialist investigations ,,. 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 ,,,.

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) .
  • Initial Investigations: Perform a urine dipstick test for proteinuria and haematuria ,. Blood tests should be conducted to assess kidney function, including serum creatinine to estimate glomerular filtration rate (eGFR) ,,.
  • 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 ,,. Specialist evaluation is crucial for understanding specific glomerular and tubulointerstitial diseases . Definitive diagnosis of specific glomerulonephritis types often relies on specialist procedures such as a kidney biopsy, which are not performed in primary care .

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