Glomerular Disease: What It Is, Causes, Symptoms, and Treatment (2023)

overview

What is glomerular disease?

Glomerular disease is the result of diseases that affect specific parts of the kidney, called the glomeruli. The glomerulus is a network of tiny blood vessels, the "cleaning unit" of the kidney. They filter waste and remove excess fluid from your blood. When the glomeruli are damaged and cannot function properly, it is called glomerular disease.

Many diseases and conditions can damage the glomeruli. Two broad terms used to describe the various forms of glomerular injury are:

• Glomerulonephritis, inflammation (swelling) of the glomeruli.
• Glomerulosclerosis, the scarring/hardening of the glomeruli.

Glomerular disease can damage your kidneys, leading to kidney failure in some cases.

How do glomeruli work in your kidneys?

Your kidneys—two bean-shaped organs located on the left and right sides of your spine below your ribcage—are your body's main filters.

Blood enters the kidneys through the arteries. Once in the kidney, the arteries branch and blood flows into a network of tiny ring-shaped blood vessels called glomeruli. Each glomerulus is attached to the opening of a small fluid-collecting tube called a tubule.Each glomerular-tubular unit is called a nephron. There are approximately 1 million nephrons in each kidney.

Properly functioning glomeruli work by keeping blood cells and proteins circulating in the blood, which your body needs. Meanwhile, the glomeruli filter out waste and excess water, sending the fluid into the tubules (which become pee). Urine (pee) leaves the kidneys through larger tubes called ureters, which carry urine to the bladder.

How does glomerular disease affect kidney function?

Glomerular disease damages the glomeruli, affecting their ability to function properly. Instead of circulating proteins and red blood cells in the blood, damaged glomeruli leak some of these products into your urine. One job of proteins in the blood, such as albumin, is to move excess fluid from the body into the blood so it can be filtered by the kidneys and excreted from the body as urine. Not having enough protein in the blood can cause excess fluid to build up in the body, causing swelling in areas such as the face, hands, feet, abdomen, and ankles.

Damaged glomeruli are also unable to filter out waste, which begins to build up in your blood.

symptoms and causes

What are the causes of glomerular disease?

Causes of glomerular disease include:

• Drugs or chemicals that are infectious or harmful to the kidneys.
• A disease that affects the whole body, including the kidneys.
• A disorder that causes swelling or scarring of the nephrons or glomeruli.
• for an unknown reason.

What are the signs and symptoms of glomerular disease?

Signs of glomerular disease include one or more of the following:

• Foamy urine (sign of protein in the urine [proteinuria]).
• Pink or light brown urine (a sign of blood in the urine [hematuria]).
• Swelling in the face/around the eyes (especially in the morning), in the hands, feet, or ankles (especially at the end of the day). This swelling is callededema.
• high blood pressure (hypertension).

Diagnosis and Testing

How is glomerular disease diagnosed?

After taking a thorough physical and medical history, your healthcare provider will order several tests, including:

• A urine test (urinalysis) to check for high protein levels, red and white blood cell levels (indicating infection or inflammation).
• Blood tests to check for low protein levels, creatinine (kidney function), and blood urea nitrogen (waste waste). A calculation called the glomerular filtration rate (GFR) is done to see if your kidneys are filtering properly.

If these lab tests show kidney damage, your healthcare provider may order:

• Additional blood tests are done for underlying causes such as infection or autoimmune disease.
• Imaging tests, including ultrasound, to see if the kidneys are abnormal in shape or size.
• A kidney biopsy involves using a needle to remove a small piece of tissue so it can be viewed under a microscope.

Management and Treatment

What diseases and conditions cause glomerular disease, and how is it treated?

Many diseases can cause glomerular disease. The goal of treatment is to treat the underlying cause (if it can be identified) to protect your kidneys from further damage. Below are some general disease categories that can cause glomerular disease, along with examples and treatments for each disease.

autoimmune disease

These are diseases in which your body's immune system attacks itself. These diseases may affect your whole body, or they may only attack specific organs or parts of your body. Autoimmune diseases that affect the kidneys include:

• Systemic Lupus Erythematosus (SLE)(Also known simply as lupus): This autoimmune disease affects many parts of the body. In the kidneys, it causes lupus nephritis, which is inflammation of the glomeruli. Inflammation can lead to scarring that prevents the kidneys from functioning properly. Anti-inflammatory treatments include immunosuppressive drugs such as mycophenolate mofetil or cyclophosphamide in combination with the corticosteroid prednisolone.
• Goodpasture Syndrome:This autoimmune disease attacks the kidneys and lungs. In the kidneys, it causes glomerulonephritis, an inflammation of the glomeruli that can lead to permanent kidney damage. Treatment includes immunosuppressant drugs and plasmapheresis (a process of removing antibodies that attack your own body).
• IgA nephropathy:With this autoimmune disease, a specific part of the immune system called the antibody immunoglobulin A (IgA) forms deposits in the glomeruli. These deposits can cause inflammation. Treatment consists of angiotensin-converting enzyme inhibitors or angiotensin receptor blockers.

hereditary nephritis

• Alport Syndrome:This is a genetic disorder that causes chronic glomerular disease and hearing or visual impairment. It affects both men and women. Men are more likely to develop chronic kidney disease, which can be diagnosed in their twenties; total kidney failure usually occurs by age 40. Treatment includes medicines to regulate blood pressure.

infection-associated glomerular disease

Glomerular disease sometimes develops rapidly after infection elsewhere in the body.

• After acute infectionglomerulus nephritis(pig):This glomerular disease occurs after an episode of strep throat or (rarely) a skin infection impetigo. The immune system overproduces antibodies to fight the infection, and these antibodies eventually deposit in the glomeruli and cause damage. Usually no treatment is needed. In rare cases, kidney dialysis or transplantation is required.
• bacteriaEndocarditis:This is an infection of the tissues inside the heart. The researchers are not sure whether the lesions that formed in the kidneys were caused by the immune response to the infection or by other disease mechanisms. Treatment is antibiotics.
• Virus:viral infections, such asHepatitis B,Hepatitis Candhuman immunodeficiency virusable cause glomerular disease. Treatment is specific to the disease.

Sclerosis

• Glomerulosclerosis:This condition is scarring (sclerosis) of the glomeruli. Lupus and diabetes are two examples of diseases that can cause glomerulosclerosis.
• Diabetes-related kidney disease:This condition is the leading cause of glomerular disease and total renal failure in the United States. Diabetes-related kidney disease damages the kidneys and raises blood sugar levels. Glucose accelerates blood flow to the kidneys, straining the glomerulus' filtering function and raising blood pressure. Common treatments include medicines to regulate blood pressure (especially ACE inhibitors or angiotensin receptor blockers), exercise, and a healthy diet.
• Focal segmental glomerulosclerosis (FSGS):This condition involves scarring of (usually) part of the glomerulus. FSGS may be the result of systemic disease or of unknown cause. Treatment aims to lower blood pressure and cholesterol levels.

other glomerular diseases

• Membranous nephropathy:This condition, also known as membranous glomerulopathy, is the second most common cause of kidney disease in adults in the United States, after diabetes-related nephropathy. It is associated with several target antigens/antibodies. This condition attacks the membrane layer of the glomerulus. Some people recover without treatment. Sometimes an angiotensin-converting enzyme inhibitor or an angiotensin receptor blocker or a calcineurin inhibitor is tried.
• Minimal Disease (MCD):This is a kidney disease in which a kidney biopsy shows little or no structural changes in the glomeruli or surrounding tissue. Tiny droplets of lipid (fatty substance) may be present, but the kidney is not scarred. MCD can occur at any age, but is most common in childhood. Treatment consists of a low-salt diet, angiotensin-converting enzyme inhibitors or angiotensin receptor blockers, and steroids, which usually relieve symptoms.

Can glomerular disease cause kidney failure?

If your kidneys can't remove waste from your blood, the waste builds up. This buildup can damage your kidneys and cause loss of function. Loss of function can be acute (sudden) or slow and persistent (chronic). Depending on the form of glomerular disease, kidney function may be lost over days or weeks, or gradually over decades.

• Acute Renal Failure (ARF):This is a rapid loss of kidney function. ARF can be life-threatening and may require urgent careDialysisreplace kidney function. In some people, kidney function returns after the cause of kidney failure is treated. No permanent damage. However, some people who recover from ARF go on to develop chronic kidney disease.
• Chronic Kidney Disease (CKD):This is a slow, gradual loss of kidney function. You may not have symptoms for many years. Some diseases that cause CKD can be slowed down, but CKD cannot be cured. Once a kidney is scarred, it cannot be repaired. CKD can lead to complete kidney failure.
• Total renal failure:Total renal failure, also known as end-stage renal disease (ESRD), is the permanent loss of kidney function. If you have complete kidney failure, you need dialysis (hemodialysisorperitoneal dialysis) orKidney transplantsurvive.

prevention

Can glomerular disease be prevented?

You can make lifestyle changes to stay healthy and reduce your risk of diseases that affect your kidneys. These changes include:

• Maintain a healthy weight.
• Keep your salt intake low; don't add extra salt to your food.
• Manage your blood pressure properly. Aim for 120/80 mmHg.
• manage your blood sugar, if you havediabetes.Take all prescribed medications and follow all management goals discussed with your healthcare provider.
• stop smoking.

It may not be possible to prevent all causes of glomerular disease. However, see your healthcare provider as soon as you notice signs of glomerular disease. It is important to discover a treatable cause and start treatment as soon as possible. Treatment may slow kidney damage and/or prevent it from getting worse.

outlook/prognosis

What should I expect if I have glomerular disease?

Early diagnosis and early treatment always have the best chance for a good outcome. The goal of treatment is to prevent or slow the progression of kidney damage. If the damage does worsen and lead to kidney failure, dialysis or a kidney transplant are the only options.

live with

What is kidney disease?

Kidney disease, also known as nephrotic syndrome, is a collection of symptoms. Large amounts of protein in the blood can end up in the urine, causing fluid to build up in the body. Symptoms include:

• Swelling (edema), especially around the eyes, feet, and hands.
• hypertension.
• high cholesterol levels.
• Low protein levels in the blood.
• High levels of protein in the urine.

The goal of treatment is to treat the underlying cause (if known). Treatment includes:

• Take an ACE inhibitor or an angiotensin receptor blocker to regulate blood pressure and stop the loss of protein into the urine.
• Reduce salt in your diet.
• Diuretics are given to reduce fluid buildup in the body.
• Taking corticosteroids or other immunosuppressive drugs.
• Take medicines to lower your cholesterol levels.
• Plasma exchange removes antibodies that attack your own body (if you have an autoimmune disease).

If the underlying cause of kidney disease is kidney disease, there is no cure. The glomeruli in the kidneys do not function properly, leading to a buildup of waste and water in the blood. Kidney failure develops. As the failure worsens, treatment is dialysis or a kidney transplant.

When should I see a doctor?

Consult your healthcare provider if you have signs or symptoms of glomerular disease or if you have any changes in your medical condition.

Note from the Cleveland Clinic

Many different diseases and conditions can damage the glomeruli in the kidneys. It's important to know your body so you can notice changes and see your healthcare provider as soon as possible.