• Kidney Disease

Glomerular Disease: Causes, Symptoms, and Treatment

The kidneys play a vital role in maintaining the body's overall health by filtering waste and excess fluids from the blood, producing urine, and regulating electrolyte balance.

Within the network of the kidneys, the glomeruli serve as essential filtration units. Glomerular disease, however, poses a significant threat to this crucial function.

What is the Glomerulus?

The glomerulus is a tiny, ball-shaped cluster of blood vessels found within the kidneys. They are specifically found inside nephrons — the filtering units of the kidney. There are about one million nephrons in each kidney.

The glomerulus is responsible for filtering blood, allowing essential substances like water, electrolytes, and nutrients to pass through while retaining blood cells and large proteins.

Within the glomerulus, the glomerular basement membrane, podocytes, and mesangial cells work together to maintain its structural integrity and function.

What is Glomerular Disease?

Glomerular disease refers to a group of conditions that affect the tiny filtering units called glomeruli in the kidneys. These glomeruli filter waste products, excess fluids, and electrolytes from the blood to form urine.

When the glomeruli become damaged or inflamed, their ability to filter blood and maintain the balance of fluids and electrolytes is disrupted. This can result in various symptoms such as proteinuria (excessive protein in the urine), hematuria (blood in the urine), decreased urine output, and high blood pressure.

Glomerular diseases can be caused by various factors, including immune system disorders, infections, genetic predisposition, or certain medications. Treatment depends on the specific underlying cause but may involve medication, lifestyle changes, or in severe cases, dialysis or kidney transplantation.

What are the Common Types of Glomerular Disease?

Nephritic and nephrotic are the two types of glomerular diseases, although there are instances where these types can overlap with certain diseases.

Glomerulonephritis

Nephritic disease – glomerulonephritis – pertains to blood in the urine (hematuria). In mild cases of glomerulonephritis, kidney function and protein levels may not be significantly affected. As a result, individuals may not experience any noticeable symptoms, and the condition could go undetected until blood and protein are identified during a routine urinalysis.

Conversely, individuals with more severe forms of glomerulonephritis may exhibit hematuria (blood in the urine) and commonly have impaired kidney function. Additionally, urine analysis may reveal elevated protein levels, and individuals may present with edema in the lower legs or high blood pressure.

The following conditions may disease the glomeruli and cause glomerulonephritis.

Alport’s syndrome

Alport's syndrome is a genetic disorder that primarily affects the kidneys and can also impact the ears and eyes.

This condition is caused by mutations in certain genes responsible for the production of collagen, which is a critical component of connective tissues. As a result, the glomerular basement membrane becomes weaker and less effective. This can lead to hematuria and proteinuria.

Over time, the progressive damage to the kidneys can result in chronic kidney disease and ultimately, kidney failure.

Alport's syndrome can also cause hearing loss and vision problems due to the structural abnormalities in the inner ear and eyes.

Although there is currently no cure for Alport's syndrome, treatments such as blood pressure control and supportive care can help manage the symptoms and slow down the progression of kidney disease. Genetic counseling may also be beneficial for individuals with a family history of Alport's syndrome.

Systemic lupus erythematosus (SLE)

Lupus – or systemic lupus erythematosus (SLE) – is a chronic autoimmune disease that can affect various organs and tissues in the body.

In lupus, the immune system mistakenly attacks healthy tissues, causing inflammation and damage. This can also extend to the glomeruli.

Lupus nephritis – a common complication of lupus – occurs when the immune system attacks the glomeruli, leading to glomerulonephritis.

This condition can impair the ability of the kidneys to filter waste products and maintain fluid balance, resulting in symptoms such as proteinuria, hematuria, and decreased kidney function.

Treatment for lupus nephritis often involves a combination of immunosuppressive medications, such as corticosteroids or immunosuppressants, to suppress the overactive immune response and reduce kidney inflammation.

Nephrotic syndrome

Nephrotic syndrome is a kidney disorder characterized by the excessive leakage of protein into the urine, resulting in low levels of protein in the blood.

When the glomeruli are injured or inflamed, they become more permeable and allow protein to escape into the urine. As a result, individuals with nephrotic syndrome may experience symptoms such as swelling, particularly in the legs and ankles, as well as fatigue and foamy urine.

Treatment for nephrotic syndrome aims to reduce protein leakage, alleviate symptoms, and protect the kidneys from further damage. This may involve the use of medications, such as corticosteroids and immunosuppressants, to reduce inflammation and control the immune response. Additionally, dietary modifications with reduced salt and protein intake may be recommended. In some cases, underlying conditions causing nephrotic syndrome, such as diabetes or certain autoimmune disorders, may also need to be managed.

The following conditions may disease the glomeruli and cause nephrotic syndrome.

Diabetic kidney disease

Diabetic kidney disease – also known as diabetic nephropathy – is a complication that can occur in individuals with diabetes.

When a person has diabetes, high blood sugar levels can gradually damage the glomeruli in the kidneys. Over time, this damage can affect the kidneys' ability to filter waste and excess fluid from the body.

As a result, protein may leak into the urine and cause waste products to build up, leading to kidney damage.

The early stages of diabetic kidney disease may not cause noticeable symptoms, but as it progresses, symptoms like swelling in the legs, increased urination, fatigue, and shortness of breath can develop.

Regular monitoring of blood sugar levels, blood pressure, and kidney function, along with proper management of diabetes, can help to prevent or slow down the progression of diabetic kidney disease.

Additionally, lifestyle changes such as adopting a healthy diet, exercising regularly, and avoiding smoking and excessive alcohol consumption can greatly reduce the risk of developing diabetic kidney disease.

Post-infectious glomerulonephritis

Post-infectious glomerulonephritis occurs after an infection – particularly caused by certain bacteria like Streptococcus – can cause nephrotic syndrome.

The immune response triggered by the infection can cause damage to the glomeruli, resulting in increased permeability of the filtration barrier. This heightened permeability allows for the leakage of larger molecules – including proteins – into the urine.

The exact mechanisms by which post-infectious glomerulonephritis leads to nephrotic syndrome are not fully understood. However, it is thought that the glomerular basement membrane is disrupted and the charge selectivity of the filtration barrier is altered, contributing to significant protein leakage.

It's important to note that not all cases of post-infectious glomerulonephritis result in nephrotic syndrome. The severity and specific effects on the glomeruli can vary among individuals. Treatment for post-infectious glomerulonephritis typically focuses on managing the underlying infection, controlling symptoms, and providing supportive care to improve kidney function.

IgA nephropathy

IgA nephropathy – also known as Berger's disease –is a kidney condition characterized by the accumulation of Immunoglobulin A (IgA) deposits in the glomeruli. The glomeruli are responsible for filtering waste products from the blood.

When IgA deposits build up, they trigger inflammation and damage the glomeruli's function.

The exact cause of IgA nephropathy is not fully understood, but it is believed to involve abnormalities in the immune system. It often follows respiratory or gastrointestinal infections, and it is more commonly found in young adults. The disease progresses slowly over time and can eventually lead to chronic kidney disease.

Symptoms of IgA nephropathy can vary and may include microscopic or visible blood in the urine, occasional flank pain, and swelling in the legs. Proteinuria (excess protein in the urine) can also occur, but it is usually less severe than in conditions like nephrotic syndrome.

Treatment for IgA nephropathy focuses on slowing down the progression of kidney damage and managing symptoms. This typically involves controlling blood pressure and reducing proteinuria through medications like angiotensin-converting enzyme inhibitors (ACE inhibitors) or angiotensin receptor blockers (ARBs).

Causes of Glomerular Disease

• Autoimmune diseases can incite the immune system to mistakenly target the glomeruli.

• Diseases like systemic lupus erythematosus (SLE) and vasculitis lead to the formation of immune complexes that deposit in the glomeruli, triggering inflammation and compromising their function.

• Glomerular diseases can arise as a consequence of infections – particularly streptococcal infections.

• Post-infectious glomerulonephritis occurs when the immune system responds to the infection and inadvertently damages the glomeruli during the process.

• Persistent high blood sugar levels in diabetes can lead to diabetic nephropathy – a condition where the glomeruli sustain damage over time due to prolonged exposure to elevated glucose levels.

• Chronic high blood pressure puts excessive strain on the delicate blood vessels within the glomeruli, gradually leading to structural damage and impaired filtration.

• Some may inherit a predisposition to glomerular diseases. Genetic mutations or a family history of kidney disorders can increase the likelihood of developing conditions such as focal segmental glomerulosclerosis (FSGS) or Alport syndrome.

Symptoms of Glomerular Disease

Proteinuria

The leakage of proteins – especially albumin – into the urine is a sign of glomerular disease. The presence of excess protein in the urine can lead to foamy or frothy urine.

Hematuria

Blood in the urine – visible as pink, red, or brown discoloration – indicates damage to the blood vessels within the glomeruli. Hematuria may be accompanied by blood clots or a change in urine color.

Edema

Swelling – particularly in the face, hands, and feet – occurs due to the retention of salt and water. This edema is a consequence of impaired kidney function and decreased urine production.

Hypertension

Elevated blood pressure is a common symptom of glomerular disease. It can be challenging to manage and may contribute to further kidney damage if not controlled.

Decreased Urine Output

Reduced urine production (or oliguria) is indicative of compromised filtration capacity. This can result in the accumulation of waste products and electrolyte imbalances.

Fatigue and Weakness

The build-up of waste products – such as urea – in the blood can lead to fatigue and weakness. Electrolyte imbalances can also contribute to muscle weakness.

How to Diagnose Glomerular Disease?

To diagnose glomerular disease, healthcare professionals employ a combination of medical history reviews, physical examinations, and diagnostic tests:

Blood and Urine Tests: Assessing levels of creatinine, blood urea nitrogen (BUN), and protein in the blood and urine.

Kidney Biopsy: A procedure in which a small sample of kidney tissue is extracted and examined under a microscope to identify the underlying cause of glomerular disease.

Imaging Studies: X-rays, CT scans, or MRIs may be utilized to visualize the structure and function of the kidneys.

Glomerular Disease Treatments

Medications

Angiotensin-converting enzyme (ACE) inhibitors and angiotensin II receptor blockers (ARBs): These medications help manage blood pressure and reduce proteinuria by dilating blood vessels and reducing the strain on the glomeruli.

Corticosteroids and immunosuppressants: In cases of autoimmune glomerular diseases, medications that suppress the immune system, such as corticosteroids and immunosuppressants, may be prescribed to alleviate inflammation and slow disease progression.

Antibiotics

Antibiotics are employed to treat infections that may be contributing to glomerular disease. Timely and targeted antibiotic therapy can help resolve the underlying infection and prevent further kidney damage.

Lifestyle Changes

Dietary modifications, including reducing salt intake and controlling protein consumption, can alleviate fluid retention and decrease the workload on the kidneys. A dietitian may assist in developing a personalized nutrition plan.

Dialysis

In advanced stages of glomerular disease where kidney function is severely compromised, dialysis becomes necessary. Two primary forms of dialysis include:

Hemodialysis: This method involves the use of a hemodialyzer – an artificial kidney machine – to filter the blood and remove excess waste and fluids. During the process, blood is directed through the machine, where it undergoes filtration before returning to the body.

This helps maintain a balance of electrolytes and fluids, managing conditions like edema and hypertension commonly associated with glomerular disease.

Peritoneal Dialysis: The peritoneum – a natural membrane lining the abdominal cavity – serves as the filter. A dialysate solution is introduced into the abdomen, and waste products move from the blood vessels in the peritoneum into the dialysate.

This method offers more flexibility as it can be performed at home, providing a continuous and gentle removal of waste products, contributing to the overall management of glomerular disease.

Kidney Transplant

For individuals with end-stage renal disease, a kidney transplant may be considered. Transplantation offers a long-term solution, restoring proper kidney function and improving overall quality of life.

How to Prevent Glomerular Disease?

While some causes of glomerular disease are beyond individual control, adopting a healthy lifestyle can contribute to overall kidney health.

• Consume a balanced diet rich in fruits, vegetables, whole grains, and lean proteins. Limit sodium and processed foods.

• Ensure an adequate intake of water to support proper kidney function.

• Engage in regular physical activity to promote cardiovascular health and regulate blood pressure.

• Regularly check and manage blood pressure and blood sugar levels, especially for individuals with diabetes.

• Smoking and excessive alcohol consumption can contribute to kidney damage, so it's essential to avoid or limit these behaviors.

Where Can You Learn More About Glomerular Disease and Other Kidney Disorders?

Glomerular disease represents several conditions that can compromise the essential functions of the kidneys. Early detection and appropriate management are important for preventing further damage and preserving kidney function.

If you’re concerned about your symptoms or want to know more about glomerular disease, LifeMD is here to help.

We can connect you to a team of medical professionals who can provide information and guidance on managing the well-being of your kidneys while avoiding long-term complications.

Make an appointment today to get started.

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