Recognition
- Cola-colored or tea-colored urine (hematuria): Classic presentation — blood in urine from damaged glomerular capillaries
- Foamy urine (proteinuria): Protein leaking through damaged glomerular basement membrane
- Periorbital edema: Especially in the morning — characteristic of nephrotic presentation
- Peripheral edema: Worsening throughout the day
- Hypertension: From fluid retention and RAAS activation
- Oliguria (reduced urine output) in acute GN
- Fatigue and malaise
- Nephritic syndrome: Hematuria, mild proteinuria, hypertension, oliguria — indicates active glomerular inflammation
- Nephrotic syndrome: Heavy proteinuria (> 3.5 g/day), severe edema, hypoalbuminemia, hyperlipidemia — indicates glomerular permeability damage
MT Relevance
- Stable, managed GN: Gentle relaxation massage with physician clearance is appropriate. Stress reduction benefits autoimmune-mediated forms.
- Acute GN with systemic symptoms (fever, severe hypertension, significant edema, oliguria): Massage is contraindicated
- Nephrotic syndrome: Severe edema makes skin fragile. Immunosuppressive medications increase infection risk — adjust pressure and apply infection precautions
- Light pressure: Edematous tissue is fragile and bruise-prone. Assess skin integrity before each session.
- Blood pressure awareness: Monitor. Avoid techniques that significantly increase blood pressure
- Immunosuppressive medications (mycophenolate, cyclophosphamide, rituximab, corticosteroids): Strict hygiene. Do not treat if the therapist is ill. Corticosteroids cause skin fragility and bruising.
- Lupus nephritis: Follow lupus-specific protocols in addition to GN considerations
- ACE inhibitors/ARBs: Reduce proteinuria but cause hypotension — slow position changes
Required Actions
- Client reports cola-colored urine, new facial swelling, or decreased urine output: Refer for medical evaluation — possible GN flare or new onset
- Severe hypertension (headache, visual changes) during session: Cease treatment and refer
- Signs of nephrotic syndrome worsening (massive edema, weight gain, shortness of breath): Urgent medical referral
Key Takeaways
- Glomerulonephritis is immune-mediated inflammation of the kidney's filtering units
- Cola-colored urine, periorbital edema, and hypertension are classic presentation features
- Often secondary to autoimmune diseases (lupus, IgA nephropathy) or post-streptococcal infection
- Massage is appropriate in stable managed cases but contraindicated during acute flares
- Immunosuppressive medications require strict infection precautions during massage