Glomerular Disease Care
Glomerulonephritis Treatment in Secunderabad — Kidney Biopsy, Precise Diagnosis, Targeted Immunotherapy
If a blood test or urine test has shown blood or protein in your urine — or if you have been told you have inflammation in your kidneys — you may have glomerulonephritis. This is a condition in which the immune system causes inflammation in the kidney's filtering units (glomeruli), impairing their ability to separate waste from blood. Glomerulonephritis comes in many distinct subtypes — each with a different cause, a different pattern on kidney biopsy, and a different treatment. Getting the right treatment depends entirely on knowing the right diagnosis, and knowing the right diagnosis requires a kidney biopsy.
At KIMS Secunderabad, glomerulonephritis is managed by DM-qualified nephrologists with specific expertise in glomerular disease. Our ultrasound-guided kidney biopsy service uses real-time imaging to ensure precision and safety, with NABL-accredited pathology providing accurate tissue diagnosis within days. Treatment is then tailored specifically to the biopsy result not a generic immunosuppression protocol applied to every case.
At a glance
Condition
Glomerulonephritis (GN) — inflammation of the kidney's filtering units (glomeruli), most commonly immune-mediated
Most common type in India/Asia
IgA Nephropathy (Berger's Disease) — presents with blood in urine and proteinuria, often after a respiratory infection
How it's diagnosed
Kidney biopsy — the only reliable way to confirm the specific GN type and choose the right treatment
Treatment approach
Type-specific immunosuppression — steroids, mycophenolate, cyclophosphamide, rituximab, tacrolimus — chosen based on biopsy result
Specialist
Dr. Aswini Dutt T — Consultant Nephrologist with specific expertise in glomerular disease and CKD
⚠ RPGN — emergency
Rapidly Progressive GN can destroy kidney function in days to weeks. Emergency immunosuppression and sometimes plasmapheresis. Call 040 - 44885000 immediately if rapid kidney function loss is suspected.
KIMS capability
Ultrasound-guided kidney biopsy · NABL pathology · Plasmapheresis for anti-GBM/ANCA · CRRT for GN-related AKI · Transplant immunosuppression expertise
Insurance
Aarogyasri (PMJAY) · CGHS · EHS · All major private insurance
Appointments
040 - 44885000 · assistance@kimshospitals.com
What is glomerulonephritis?
The kidneys contain approximately one million filtering units called glomeruli — microscopic networks of tiny blood vessels that separate waste from the blood. In glomerulonephritis, these filtering units become inflamed, most commonly due to the immune system depositing antibodies or immune complexes within the glomerular structures. This inflammation damages the vessel walls, causing blood and protein to leak into the urine, and progressively impairing filtration — raising creatinine and reducing eGFR.
Glomerulonephritis can be primary (originating in the kidney with no identifiable systemic disease) or secondary (a manifestation of a systemic condition such as lupus, vasculitis, diabetes, or infection). The distinction matters because secondary GN requires treatment of the underlying systemic disease alongside kidney-specific therapy.
Symptoms — how glomerulonephritis presents
Presentation varies significantly by subtype, but these are the most common findings that lead to a GN diagnosis. Early detection through urine analysis is critical as many symptoms only appear once damage is significant.
⚠ RPGN — MEDICAL EMERGENCY
If kidney function (creatinine) is rising rapidly over days to weeks — particularly combined with blood in urine, declining urine output, and new severe hypertension — this may be Rapidly Progressive Glomerulonephritis (Crescentic GN).
This can cause irreversible kidney failure within days without emergency treatment. Go to KIMS Emergency immediately or call 040 - 44885000. Every hour of delay in starting immunosuppression in RPGN causes permanent kidney damage.
Haematuria — blood in the urine, appearing pink, red, or tea-coloured, or detected microscopicially
Proteinuria — protein leaking into the urine, causing it to appear frothy or foamy
Oedema — swelling of the face (particularly around the eyes), legs, and ankles
Hypertension — new or worsening high blood pressure from impaired salt and water regulation
Reduced urine output — seen in more severe or acute presentations
Fatigue and reduced exercise tolerance — resulting from anaemia and declining kidney function
Post-infection symptoms — haematuria and oedema presenting 1–3 weeks after throat or skin infection
RPGN Warning — Rapid loss of kidney function over days to weeks (Medical Emergency)
Why a kidney biopsy is essential — demystifying the procedure
The kidney biopsy is not a procedure to be avoided — it is the procedure that makes treatment possible. Without a biopsy, glomerulonephritis cannot be definitively diagnosed, classified, or appropriately treated. Giving the wrong immunosuppression for the wrong GN subtype does not just fail to help — it can cause significant harm. The biopsy result is the foundation of every treatment decision.
At KIMS Secunderabad, kidney biopsies are performed under real-time ultrasound guidance — the kidney is visualised throughout the procedure to ensure the needle is precisely placed in the correct position, minimising the risk of bleeding. A local anaesthetic is injected before the needle is inserted — most patients experience only mild pressure, not pain. The procedure takes approximately 30 to 45 minutes. Two small tissue samples are taken and sent for light microscopy, immunofluorescence staining (which identifies which antibodies are deposited), and electron microscopy — together, these three examinations identify the GN subtype with precision.
| Feature | KIMS Specifics |
|---|---|
| Guidance | Real-time ultrasound — the kidney is visible throughout the procedure |
| Anaesthesia | Local anaesthetic injection — no general anaesthesia required |
| Duration | 30–45 minutes total |
| Admission | Day case — most patients discharged the same day after 6 hours observation |
| Pain | Mild pressure during needle pass — most patients describe discomfort rather than pain |
| Pathology Results | Comprehensive report within 3–5 working days |
| Laboratory Accreditation | NABL-accredited KIMS laboratory — results meet international quality standards |
| Safety Record | Risk of significant bleeding is less than 1 in 200 cases due to precision guidance |
Types of glomerulonephritis — the subtypes KIMS manages
Glomerulonephritis is not a single disease, but a group of conditions with different causes and treatments. KIMS Secunderabad provides specialized management for each subtype based on precise biopsy diagnosis and international guidelines.
1 — IgA Nephropathy (Berger's Disease) — the most common type in India
IgA Nephropathy is the most common primary glomerulonephritis worldwide, and particularly prevalent in Asian populations. It is caused by abnormal IgA antibody complexes depositing in the glomeruli, triggering inflammation. It typically presents in young adults (20s–40s). Common presentations: • Visible blood in urine during or just after a respiratory or gastrointestinal infection ('synpharyngitic haematuria') • Persistent microscopic haematuria found on routine urinalysis • Proteinuria — sometimes heavy • Slowly progressive decline in kidney function over years to decades Treatment at KIMS: For low-risk cases, we focus on supportive therapy—optimal blood pressure control with RAAS blockade, SGLT2 inhibitors, and dietary sodium restriction. For higher-risk disease (proteinuria > 1 g/day), targeted sparsentan or a course of systemic corticosteroids may be added, following current KDIGO 2021 guidelines.
2 — Membranous Nephropathy
Membranous Nephropathy is the most common cause of nephrotic syndrome in adults over 40. It is caused by antibodies (most commonly anti-PLA2R antibodies) depositing in the glomerular basement membrane. It presents with heavy proteinuria, oedema (leg and facial swelling), and foamy urine. At KIMS, anti-PLA2R antibody testing is performed as part of diagnosis—a positive test may allow delayed or avoided biopsy in some cases. Treatment is risk-stratified: low-risk patients are managed conservatively, while high-risk patients receive advanced immunosuppression with rituximab (now first-line) or cyclophosphamide-based regimens.
3 — Focal Segmental Glomerulosclerosis (FSGS)
FSGS is characterised by scarring (sclerosis) affecting segments of some (focal) glomeruli. It is a leading cause of kidney failure in younger adults and may be primary (idiopathic) or secondary (caused by obesity, reflux, or systemic disease). Primary FSGS is treated with corticosteroids as first-line, with calcineurin inhibitors (tacrolimus), mycophenolate mofetil, or rituximab for steroid-resistant cases. Secondary FSGS treatment focuses on managing the underlying cause.
4 — Lupus Nephritis (LN)
Lupus nephritis is kidney inflammation occurring as part of Systemic Lupus Erythematosus (SLE). Approximately 50% of SLE patients develop significant kidney involvement. At KIMS, LN is managed by the nephrologist in coordination with rheumatology. We use hydroxychloroquine as background therapy for all patients, combined with high-dose steroids and mycophenolate mofetil or cyclophosphamide for proliferative classes. Belimumab and voclosporin are available for persistent active disease.
5 — ANCA-Associated Vasculitis (AAV)
AAV (including GPA and MPA) involves small blood vessel inflammation throughout the body. The kidneys are a primary target, often presenting with a rapidly progressive kidney failure (RPGN) pattern. Treatment at KIMS: High-dose corticosteroids combined with either cyclophosphamide or rituximab. For severe cases involving pulmonary haemorrhage or dialysis-dependent failure, KIMS provides immediate plasmapheresis to remove circulating antibodies.
6 — Anti-GBM Disease (Goodpasture Syndrome)
Anti-GBM disease is a rare but severe condition where antibodies attack the kidney's filtering membrane, often causing simultaneous lung haemorrhage. This is a medical emergency. Treatment at KIMS requires immediate daily plasmapheresis to remove antibodies, combined with high-dose steroids and cyclophosphamide. Without emergency intervention, kidney function recovery is unlikely.
7 — Post-Infectious Glomerulonephritis
Post-streptococcal GN typically occurs 1 to 3 weeks after a throat or skin infection. It presents with haematuria, oedema, and hypertension, most commonly in children. Unlike other GN types, this is usually self-limiting. Treatment at KIMS focuses on antibiotics to eradicate residual infection, blood pressure control, and diuretics for fluid overload. The prognosis is generally excellent, especially in pediatric cases.
Why choose KIMS Secunderabad for glomerulonephritis?
Glomerulonephritis is a complex subspecialty of nephrology. KIMS provides the precise diagnostic infrastructure and advanced therapeutic capabilities required for successful management.
Ultrasound-guided kidney biopsy with NABL pathology
The kidney biopsy determines every subsequent treatment decision in GN. At KIMS, all biopsies are performed under real-time ultrasound guidance by experienced nephrologists, with specimens processed in our NABL-accredited laboratory for light microscopy, immunofluorescence, and electron microscopy. Results are reported within 3 to 5 working days.
Specific glomerular disease expertise
Dr. Aswini Dutt T, Consultant Nephrologist at KIMS Secunderabad, has specific expertise in glomerular disease management — including the complex immunosuppression protocols required for each GN subtype. The difference in outcomes between subspecialty glomerular care and general nephrology is significant.
Plasmapheresis for anti-GBM and ANCA vasculitis
Anti-GBM disease and severe ANCA vasculitis require plasmapheresis — a life-saving procedure not available at every centre. KIMS has full plasmapheresis capability, meaning patients with these rapidly destructive conditions can be treated immediately without needing a hospital transfer.
CRRT for GN-related acute kidney injury
RPGN and other severe GN presentations can cause rapidly progressive AKI requiring dialysis support while immunosuppression takes effect. KIMS provides 24/7 CRRT (Continuous Renal Replacement Therapy) for haemodynamically unstable patients who need continuous kidney support.
Immunosuppression expertise from transplant programme
The same medications used to prevent transplant rejection — tacrolimus, mycophenolate, cyclophosphamide, and rituximab — are the pillars of complex GN management. Our extensive transplant programme ensures our nephrologists are experts in managing these high-potency agents safely.
Integrated multidisciplinary care
For secondary glomerulonephritis caused by systemic conditions like Lupus, we coordinate directly with our rheumatology and clinical immunology departments to provide one unified treatment plan for both the kidney and the underlying systemic disease.
Book a Glomerular Disease Assessment at KIMS
Our glomerulonephritis specialists at KIMS Secunderabad
Glomerular disease management requires high-level subspecialty expertise. Our team led by Dr. Aswini Dutt provides precise diagnostic and therapeutic care for all complex GN subtypes.
Frequently Asked Questions
Glomerulonephritis (GN) is inflammation of the kidney's filtering units (glomeruli) — most commonly caused by the immune system depositing antibodies within the glomerular structures. This distinguishes it from most other kidney diseases, which are caused by diabetes, high blood pressure, obstruction, or infection rather than immune attack. Because GN is immune-mediated, its treatment uses immunosuppressive medications — steroids, mycophenolate, cyclophosphamide, rituximab — rather than the blood sugar or blood pressure medications used in diabetic or hypertensive nephropathy. The specific immunosuppressive regimen depends entirely on the GN subtype identified by kidney biopsy.
For most types of glomerulonephritis, yes — a kidney biopsy is the only reliable way to identify the specific subtype and therefore choose the correct treatment. 'Glomerulonephritis' is not a single disease — it is a group of conditions with different causes, different appearances on biopsy, and different treatments. Giving the wrong immunosuppression for the wrong GN type can fail to treat the condition and cause significant medication side effects. At KIMS, biopsies are performed under ultrasound guidance, taking approximately 30 to 45 minutes under local anaesthetic — most patients are discharged the same day and describe only mild discomfort rather than pain.
IgA Nephropathy (Berger's Disease) is the most common glomerulonephritis worldwide, particularly in Asian populations including India. It is caused by abnormal IgA antibody deposits in the glomeruli, triggering inflammation. It typically presents with blood in the urine — often appearing during or just after a respiratory infection. Treatment at KIMS is risk-stratified: low-risk patients receive optimised blood pressure control with RAAS blockade and SGLT2 inhibitors. Higher-risk patients (persistent proteinuria, falling eGFR) may receive corticosteroids or newer targeted therapies. With careful specialist management, many patients maintain stable kidney function for decades.
Rapidly Progressive Glomerulonephritis (RPGN), also called Crescentic GN, is a severe form of glomerulonephritis characterised by the formation of 'crescents' (abnormal cellular deposits) in the glomeruli on biopsy — causing a rapid, potentially irreversible decline in kidney function over days to weeks. Without emergency treatment, most patients with RPGN will require permanent dialysis. At KIMS, RPGN is treated as a medical emergency: same-day kidney biopsy where possible, immediate high-dose immunosuppression (intravenous methylprednisolone 'pulse' steroids), cyclophosphamide or rituximab, and plasmapheresis for cases of anti-GBM disease or ANCA vasculitis. Every hour of delay causes additional permanent kidney damage. Call 040 - 44885000 immediately.
Outcome depends on the specific subtype. Post-streptococcal GN: usually cures completely without specific treatment in children, with very good outcomes in adults. IgA Nephropathy: cannot be cured, but with specialist management most patients can maintain functional kidney health for many years. Membranous Nephropathy: approximately 30% remit spontaneously; others achieve remission with immunosuppression (rituximab). FSGS: can achieve complete or partial remission with treatment in many patients. Lupus Nephritis: can be controlled with immunosuppression — relapse is common, requiring long-term monitoring. ANCA vasculitis and anti-GBM disease: remission is achievable with aggressive treatment, but vigilance for relapse is essential. KIMS provides lifelong monitoring for all GN patients.
Treatment depends entirely on the biopsy-confirmed GN subtype. The main categories at KIMS: corticosteroids (prednisolone — first-line in most GN types, as high-dose oral or intravenous pulse therapy); mycophenolate mofetil (MMF — used in lupus nephritis, FSGS, and membranous nephropathy); cyclophosphamide (for ANCA vasculitis, anti-GBM disease, and severe lupus nephritis); rituximab (anti-CD20 monoclonal antibody — now first-line for membranous nephropathy and ANCA vasculitis at many centres including KIMS); tacrolimus or cyclosporin (calcineurin inhibitors for steroid-resistant FSGS and lupus nephritis); belimumab or voclosporin (for refractory lupus nephritis). All these medications require careful monitoring for side effects and drug levels — which KIMS's NABL-accredited laboratory supports.
Treatment duration varies significantly by subtype and response. Post-streptococcal GN: supportive treatment for weeks only. For other primary GN types (IgA, membranous, FSGS): initial immunosuppression courses typically last 6 to 12 months; many patients then require ongoing monitoring with maintenance therapy. For lupus nephritis: lifelong hydroxychloroquine; maintenance immunosuppression (mycophenolate mofetil) for at least 3 years, and often indefinitely in active disease. For ANCA vasculitis: maintenance rituximab or azathioprine for at least 2 years. All GN patients at KIMS are enrolled in a structured follow-up programme with defined monitoring schedules for kidney function, urine protein, and immunosuppression levels.
KIMS Secunderabad's glomerular disease programme provides ultrasound-guided kidney biopsy with NABL-accredited pathology, type-specific immunosuppression protocols for every GN subtype, plasmapheresis for anti-GBM disease and ANCA vasculitis, CRRT for GN-related acute kidney injury, and 24/7 emergency nephrology for RPGN. Dr. Aswini Dutt T brings specific glomerular disease expertise. KIMS's transplant immunosuppression programme means our nephrologists manage the same complex medications daily. KIMS is Times Healthcare Nephrology Award winner, NABH and NABL accredited, and empanelled under Aarogyasri, CGHS, and EHS.