Glomerular Diseases

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Glomerular Diseases: Description

Glomerular diseases involve many conditions that damage the glomeruli—the tiny structures within the kidney. The glomeruli (singular form is glomerulus) help to clean the blood of wastes by acting as filters.

When a glomerular disease damages the glomeruli, proteins and red blood cells can leak into the urine. Proteins in the blood like albumin are important in taking out extra fluid from the body. It acts like a sponge that draws the extra fluid into the bloodstream, where it stays until the kidneys remove it. However, when albumin leaks into the urine, the blood will not be able to absorb the excess fluid from the body. This results in fluid accumulation in the face, hands, feet, or ankles, which lead to swelling.

Glomerular diseases can also interfere with the clearance of waste products by the kidneys, which results in wastes building up in the blood.

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Signs and Symptoms:

Signs and symptoms of a glomerular disease may include:

 Blood in the urine (hematuria). Urine may be colored pink or the color of cola.

 Foamy urine. This is due to the large amounts of protein in the urine—a term called proteinuria.

 Swelling (edema) in the hands and ankles, especially at the end of the day, or around the eyes when awakening in the morning.

 Reduced glomerular filtration rate (GFR). GFR is a calculation of how efficiently the kidneys are filtering wastes from the blood.

 Hypoproteinemia: low concentration of proteins in the blood

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A variety of diseases can result in glomerular disease. It may result from infection or drugs that are toxic to the kidneys. Diseases that affect the entire body like diabetes and lupus can also cause it to develop. Others may also cause swelling or scarring of the glomerulus.

Causes of glomerular disease may include

 Autoimmune diseases, such as lupus, Goodpasture’s syndrome, and IgA nephropathy. An autoimmune disease occurs when the body’s immune system attacks the body itself.

 Infections. Glomerular disease can sometimes develop rapidly after an infection in other parts of the body. This may include acute post-streptococcal glomerulonephritis (PSGN), bacterial endocarditis, and HIV—the virus that leads to AIDS.

 Sclerotic diseases, such as glomerulosclerosis, diabetic nephropathy, and focal segmental glomerulosclerosis (FSGS). These conditions can cause scarring or hardening of structures within the kidneys.

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Tests and Diagnosis

Your doctor may test a sample of your urine for significant amounts of protein. If it shows high levels of protein, it is referred to as “nephrotic range”. In some forms of glomerular disease, red blood cells in the urine are frequent findings. Urine analysis is an important diagnostic tool in providing information about kidney damage by indicating levels of protein and red blood cells in the urine.

To know whether the filtering capacity of the kidneys is impaired, your doctor will also check a sample of your blood. Blood tests are used to provide information about levels of waste products such as creatinine and urea nitrogen in the blood.

If laboratory tests indicate kidney damage, the doctor may recommend renal imaging such as ultrasound or an x ray. These are used to see whether there are abnormalities in the size or shape of the kidneys.

The doctor may also recommend kidney biopsy, which may be helpful in confirming glomerular disease and identifying the cause. In biopsy, a needle is used to extract a small sample of kidney tissue for examination with different types of microscopes. This will show different aspects of the tissue. Kidney biopsy helps to identify problems of the kidneys at the cellular level.

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Although glomerular disease has different causes, it can lead to kidney failure. Kidney or renal function may be lost in a matter of days or weeks or may slowly and gradually deteriorate over the years.

Treatment or management of the early stages of kidney failure depends on the disease causing the damage. For example, people with diabetic nephropathy can help slow down damage to their kidneys by controlling their blood sugar through healthy eating, physical activity, and medications.

When glomerular disease causes the kidneys to totally stop working, dialysis or kidney transplantation may be the only options of treatment. By working with their kidney health care team, many people with total kidney failure continue to lead full, productive lives.

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National Kidney and Urologic Diseases Information Clearinghouse. Glomerular Diseases. Available at http://kidney.niddk.nih.gov/kudiseases/pubs/glomerular/index.htm#failure
National Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD. NIH Publication No. 06-4358, April 2006. Retrieved July 3, 2008

National Kidney and Urologic Diseases Information Clearinghouse. Proteinuria. Available at http://kidney.niddk.nih.gov/kudiseases/pubs/proteinuria/index.htm
National Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD. NIH Publication No. 06-4732, September 2006. Retrieved July 3, 2008

National Kidney and Urologic Diseases Information Clearinghouse. Your Kidneys and How They Work. Available at http://kidney.niddk.nih.gov/kudiseases/pubs/yourkidneys/index.htm#rate
National Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD. NIH Publication No. 07-3195, August 2007. Retrieved July 3, 2008

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