Glomerular Diseases: Symptoms, Causes, Treatment

What are the symptoms of glomerular disease?

Glomerular disease refers to a group of conditions that affect the glomeruli, which are the tiny filters in your kidneys that help remove excess fluids, electrolytes, and waste from your bloodstream. Symptoms of glomerular disease can vary depending on the specific condition and its severity, but common symptoms may include:

1. Proteinuria: Excess protein in the urine, which can cause foamy urine.
2. Hematuria: Blood in the urine, which may make the urine pink, red, or cola-colored.
3. Edema: Swelling, usually in the legs, ankles, feet, or around the eyes, due to fluid retention.
4. Hypertension: High blood pressure, which can be a result of kidney dysfunction.
5. Fatigue: Feeling tired or weak, often due to anemia caused by reduced production of red blood cells.
6. Reduced urine output: Decreased frequency of urination or reduced volume of urine.
7. Increased or decreased thirst: Fluctuations in thirst levels, which may be due to fluid imbalances.
8. Hypoalbuminemia: Low levels of albumin (a protein) in the blood, which can contribute to edema.
9. Elevated cholesterol levels: High levels of cholesterol in the blood, often due to kidney dysfunction.
10. Nausea and vomiting: These symptoms can occur as a result of waste buildup in the blood (uremia).

It’s important to note that symptoms can vary widely, and some people with glomerular disease may not experience any symptoms until the condition has progressed significantly. If you suspect you have glomerular disease, it’s essential to see a healthcare provider for a proper diagnosis and treatment.

What are the causes of glomerular disease?

Glomerular disease refers to a group of kidney disorders that affect the glomeruli, which are the tiny blood vessels in the kidneys that filter waste and excess fluids from the blood. The causes of glomerular disease can be classified into several categories:

1. Immune-mediated glomerular disease: This type of disease occurs when the immune system mistakenly attacks the glomeruli, leading to inflammation and damage. Examples include:
   • Lupus (SLE)
   • Rheumatoid arthritis
   • Vasculitis (inflammation of blood vessels)
2. Infections: Certain bacterial, viral, or parasitic infections can cause glomerular disease, such as:
   • Post-infectious glomerulonephritis (PIGN) after streptococcal infections
   • HIV-associated nephropathy
3. Genetic disorders: Certain genetic conditions can increase the risk of developing glomerular disease, such as:
   • Alport syndrome
   • Fabry disease
   • Thin basement membrane disease (also known as Goodpasture syndrome)
4. Environmental factors: Exposure to certain substances or toxins can damage the glomeruli, leading to disease, such as:
   • Mercury toxicity (e.g., from mercury exposure in fish or industrial settings)
   • Heavy metal toxicity (e.g., lead, cadmium)
   • Pesticide exposure
5. Hormonal imbalances: Hormonal changes can contribute to the development of glomerular disease, such as:
   • Thyroid disorders (e.g., hyperthyroidism or hypothyroidism)
   • Cushing’s syndrome
6. Other factors:
   • Age: Glomerular disease is more common in older adults.
   • Obesity: Being overweight or obese may increase the risk of developing glomerular disease.
   • Hypertension: High blood pressure can damage the glomeruli over time.
   • Diabetes: Uncontrolled diabetes can damage the glomeruli and lead to kidney disease.
7. Unknown causes: Some cases of glomerular disease may not have a clear cause or trigger.

It’s essential to note that many cases of glomerular disease are idiopathic, meaning that the cause is unknown. A healthcare provider will typically conduct a thorough medical history, physical examination, and laboratory tests to diagnose and determine the underlying cause of glomerular disease.

How is the diagnosis of glomerular disease made?

The diagnosis of glomerular disease typically involves a combination of the following steps:

1. Medical history: The healthcare provider will ask questions about the patient’s medical history, including:
   • Symptoms: Such as blood in the urine, proteinuria (excess protein in the urine), or hematuria (blood in the urine).
   • Kidney function: Any changes in kidney function, such as decreased urine output or swelling.
   • Family history: A history of kidney disease or other relevant medical conditions.
   • Medications: Any medications being taken and their potential side effects on the kidneys.
2. Physical examination: The healthcare provider will perform a physical examination to look for signs of kidney disease, such as:
   • Edema (swelling): Swelling in the legs, ankles, or feet.
   • Hypertension: High blood pressure.
   • Pale skin: Pale skin due to anemia.
3. Urine tests: Urine samples will be collected and analyzed for:
   • Proteinuria: Excess protein in the urine, which can indicate kidney damage.
   • Hematuria: Blood in the urine, which can indicate glomerular damage.
   • Microalbuminuria: Small amounts of albumin (a type of protein) in the urine, which can indicate early kidney damage.
   • Urine sediment analysis: Examination of the sediment under a microscope to look for abnormal cells, casts, or crystals that may indicate glomerular disease.
4. Blood tests: Blood samples will be taken to measure:
   • Serum creatinine: A waste product that is removed from the blood by the kidneys, elevated levels can indicate kidney damage.
   • Blood urea nitrogen (BUN): A waste product that is removed from the blood by the kidneys, elevated levels can indicate kidney damage.
   • Complete blood count (CBC): To rule out other conditions that may be causing symptoms similar to glomerular disease.
5. Imaging tests: Imaging tests may be ordered to evaluate kidney structure and function, such as:
   • Ultrasound: To visualize the kidneys and assess their size and shape.
   • CT scan or MRI: To evaluate the kidneys and surrounding tissues.
6. Kidney biopsy: In some cases, a kidney biopsy may be performed to:
   • Obtain a tissue sample for microscopic examination to diagnose glomerular disease.
   • Assess the extent of glomerular damage.
7. Immunological tests: Immunological tests may be performed to identify specific antibodies or immune complexes that may be contributing to glomerular disease.

After collecting these data, the healthcare provider will use a combination of clinical presentation, laboratory test results, and imaging studies to make a diagnosis and develop a treatment plan.

What are the treatments for glomerular disease?

The treatment for glomerular disease depends on the underlying cause and severity of the condition. The goal of treatment is to slow or stop the progression of kidney damage, manage symptoms, and prevent complications. Here are some common treatments for glomerular disease:

1. Medications:
   • Corticosteroids: To reduce inflammation and slow the progression of disease.
   • Immunosuppressants: To suppress the immune system and prevent further damage.
   • Antibiotics: To treat infections that may be contributing to glomerular disease.
   • Blood pressure medications: To control hypertension and prevent further kidney damage.
   • Diuretics: To reduce fluid buildup and alleviate swelling.
2. Dietary changes:
   • Reduced protein intake: To slow down the progression of kidney disease.
   • Limited sodium intake: To reduce blood pressure and fluid retention.
   • Potassium-rich diet: To help regulate blood pressure.
   • Phosphorus-restrictive diet: To manage phosphate levels in the blood.
3. Fluid management:
   • Fluid restriction: To reduce fluid overload and prevent edema.
   • Diuretics: To help remove excess fluids from the body.
4. Blood pressure control:
   • Medications to lower blood pressure, such as ACE inhibitors or ARBs.
5. Immune-modulating therapies:
   • Plasmapheresis: A process that removes abnormal antibodies from the blood to reduce inflammation.
6. Supportive care:
   • Dialysis: A treatment that filters waste products from the blood when the kidneys are no longer able to do so.
   • Renal replacement therapy: A process that replaces the function of the kidneys using a machine or a living donor kidney.
7. Kidney transplantation: A surgical procedure that replaces a diseased kidney with a healthy one from a donor.

Specific treatment options for different types of glomerular diseases include:

• Lupus nephritis: Corticosteroids, immunosuppressants, and plasmapheresis may be used to treat lupus nephritis.
• Rheumatoid arthritis: Disease-modifying antirheumatic drugs (DMARDs) may be used to manage rheumatoid arthritis-related glomerular disease.
• Hematuria: Antibiotics may be used to treat underlying infections that cause hematuria.
• Nephrotic syndrome: Diuretics, ACE inhibitors, and statins may be used to manage nephrotic syndrome.

It’s essential to work closely with a healthcare provider to develop a personalized treatment plan that addresses the specific needs and underlying causes of the glomerular disease.