Understanding Glomerular Diseases

What is glomerular disease?

Your kidneys may be small, but they perform many vital functions that help maintain your overall health, including filtering waste and excess fluids from your blood. Your kidneys have about one million tiny filter units called nephrons. Each nephron has a glomerulus, so that means there are over one million of them too.  More than one glomerulus are called glomeruli. Glomeruli work like strainers used in cooking. While blood moves through them, they let waste and extra water pass into the nephrons to make urine. At the same time, they hold back the protein and blood that your body needs. Many diseases affect kidney function by attacking the glomeruli. When the glomeruli become damaged and cannot do their job, it is called glomerular disease. Glomerular diseases include many conditions with many different causes.

What causes glomerular disease?

Glomerular disease may be caused by an infection or a drug that is harmful to your kidneys. In other cases, it may be caused by a disease that affects the entire body, like diabetes or lupus. Many different diseases can cause swelling (inflammation) or scarring (sclerosis) of the glomerulus. Sometimes glomerular disease is idiopathic, meaning it happens without any cause that can be found.

What are the signs and symptoms of glomerular disease?

One or more of the following can be the first sign of glomerular disease:

• Blood in the urine (hematuria): Glomerular disease can cause your glomeruli to leak blood into your urine. Your urine may look pink or light brown from blood.
• Protein in the urine (proteinuria): Glomerular disease can cause your glomeruli to leak protein into your urine. Your urine may be foamy because of the protein.
• Edema: Glomerular disease can cause fluid to build up in your body. The extra fluid can cause swelling in body parts like your hands, ankles, or around your eyes.

If you have one or all of these symptoms, be sure to see your healthcare provider right away.

How is glomerular disease diagnosed?

The first clues are the signs and symptoms. Blood tests will help your healthcare provider tell you what type of illness you have and how much it has hurt your kidneys.

A simple test of your urine can confirm if there is blood or protein in the urine.

In some cases, a test called a kidney biopsy may be needed. In this test, a tiny piece of your kidney is removed with a special needle, and looked at under a microscope. A biopsy will help your healthcare provider plan the best treatment for you.

What treatment is available for glomerular disease?

Your healthcare provider will need to find what is causing your glomerular disease. The goals of treatment are to help your symptoms, avoid complications, and slow down the damage to your kidneys. Sometimes you may need medication or temporary treatment with an artificial kidney machine to remove extra fluid, control high blood pressure and treat kidney failure.

Overall, there is no one specific treatment that works for all glomerular diseases, but your doctor may tell you to:

• Control your blood pressure and stop protein loss in the urine with drugs called ACE inhibitors or ARBs
• Take diuretics (water pills) to treat  swelling in ankles and feet
• Make certain changes in your diet such as eating less salt

• Take medications that make your immune system less active (for example, corticosteroids)

Will glomerular disease cause chronic kidney disease?

Over time, glomerular disease may stop your kidneys from getting rid of wastes in your blood. When this goes on for a long time, waste builds up in your blood, and you may have chronic kidney disease. This can progress to kidney failure. It is important to speak with your healthcare provider to find the treatment plan that works best for you and try to help slow down the damage to your kidneys.

What can I do to prevent glomerular disease?

It is important to pay attention to signs and symptoms and let your healthcare provider know as early as possible when you notice them. Treating conditions that can cause glomerular disease may help prevent it from getting worse and slow down the damage to your kidneys.

What else should I know?

Some people with glomerular disease have nephrotic syndrome. Nephrotic syndrome (also called nephrosis) happens when your kidneys lose large amounts of protein in your urine and causes extra fluids and salt build up in your body. This causes you to have swelling (edema), high blood pressure, and higher levels of cholesterol. Nephrotic syndrome may come from kidney diseases or from other illnesses such as diabetes and lupus. Some medicines, IV drug abuse, and HIV (the AIDS virus) may also cause it.  In some people, nephrotic syndrome goes away after treatment. But for others, this condition may last for many years and over time, lead to kidney failure.

Other people may not have nephrotic syndrome, but still have some signs of it, such as protein in their urine, edema, and high blood pressure. They may also have other signs that are not part of nephrotic syndrome, such as blood in the urine, inflammation of glomeruli, and lower kidney function because of kidney damage. If you have all of these extra signs, then you may have nephritic syndrome, which is caused by inflammation in the filters of the kidney.

What treatment is available for nephrotic or nephritic syndrome?

If possible, the disorder  causing it is treated.   If your illness is getting worse very quickly, you may need high doses of medicine that affect your immune system. Sometimes your doctor may order plasmapheresis, a special blood filtering process to remove harmful proteins from your blood.

Your doctor may also suggest:

• Control your blood pressure and stop protein loss in the urine with drugs called ACE inhibitors or ARBs
• Take diuretics (water pills) to treat swelling in ankles and feet
• Make certain changes in your diet such as eating less salt
• Take medications that make your immune system less active (for example, corticosteroids)
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Your healthcare provider will work to understand the cause of your symptoms and help find the best treatment for you.