Introduction
The conditions affecting the tiny filters in the kidneys that remove waste and excess fluid from the blood, result in glomerular disease. When the glomeruli are damaged and unable to perform their functions properly, it leads to glomerular disease. This disease can be caused by various factors such as infections, autoimmune disorders, and genetic predisposition.
What Are the Types?
Two types of damage to the glomeruli are described by the terms glomerulonephritis, which is inflammation of the glomeruli, and glomerulosclerosis, which is scarring and hardening of the glomeruli. Glomerular disease can cause significant kidney damage and, in severe cases, even lead to kidney failure.
What Is Glomeruli?
The kidneys, two bean-shaped organs located on either side of the spine just below the rib cage, serve as the primary filters of the body. Blood flows into the kidneys through arteries, which branch and enter the glomeruli, a network of small looping blood vessels. Each glomerulus is attached to a small fluid-collecting tube known as a tubule, and this combination of glomerulus and tubule is referred to as a nephron. There are approximately one million nephrons in each kidney.
The glomeruli keep essential blood cells and proteins in circulation within the bloodstream while filtering out waste products and excess water, which are then passed into the tubule and eventually become urine. The urine is then transported from the kidneys to the bladder through larger tubes called ureters.
How Do Glomerular Diseases Impact Kidney Function?
Glomerular diseases cause harm to the glomeruli, resulting in the leakage of protein and, at times, red blood cells into the urine. Additionally, these diseases can impede the kidney's ability to eliminate waste products, causing them to accumulate in the blood. The loss of blood proteins, such as albumin, in the urine, can decrease their levels in the bloodstream. Normally, albumin functions as a sponge in the blood, drawing excess fluid from the body into the bloodstream, where the kidneys can remove it. However, when albumin leaks into the urine, the blood loses its ability to absorb excess fluid from the body, leading to fluid accumulation outside the circulatory system and swelling in the face, hands, feet, or ankles.
What Are the Causes?
Glomerular diseases can be caused by various factors, such as:
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Infections: Certain infections, such as streptococcal infections, hepatitis B and C, and HIV, can lead to glomerular disease.
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Autoimmune Disorders: Diseases such as lupus, IgA nephropathy (Berger's disease), and Goodpasture's syndrome can damage the glomeruli.
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Genetic Predisposition: Some individuals may be predisposed to glomerular disease due to inherited genetic factors.
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Drug Toxicity: Certain medications and chemicals can cause damage to the glomeruli.
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Degenerative Conditions: Progressive conditions like diabetes, high blood pressure, and amyloidosis can lead to glomerular disease.
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Trauma: Physical injury or trauma to the kidney can result in glomerular damage.
What Are the Symptoms?
The signs and symptoms of the glomerular disease can vary depending on the underlying condition but may include the following:
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Foamy Urine: Due to the presence of excess protein in the urine.
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Swelling: Edema, especially in the face, hands, feet, ankles, or legs.
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High Blood Pressure: Also known as hypertension.
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Dark-Colored Urine: Due to the presence of red blood cells in the urine.
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Fatigue and Weakness: Due to anemia, a condition with a lack of red blood cells in the body.
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Decreased Urine Output: Also known as oliguria.
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Blood In the Urine: Hematuria.
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Abdominal Pain: Due to a buildup of waste products in the blood.
How Is the Condition Diagnosed?
Diagnosis of the glomerular disease usually involves a comprehensive medical examination and review of the medical history, followed by various tests, including:
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Urinalysis: To assess for elevated protein levels, the presence of red blood cells, and white blood cell count (which could indicate infection or inflammation).
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Blood Tests: To check for low protein levels, creatinine (a marker of kidney function), and urea nitrogen levels (a waste product). The glomerular filtration rate (GFR) is also calculated to determine if the kidneys function properly.
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Additional Blood Tests: To investigate potential causes such as infections or autoimmune diseases.
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Imaging Tests: For example, ultrasound examines the shape and size of the kidneys.
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Kidney Biopsy: This involves taking a sample of kidney tissue through a needle for microscopic examination.
These tests help determine the underlying cause of the glomerular disease and guide the appropriate course of treatment.
Can Glomerular Disease Result in Kidney Failure?
If the kidneys cannot eliminate waste from the blood, waste accumulates, leading to damage to the kidneys and a decrease in their functionality. This loss of function can be sudden or gradual. The rate at which kidney function is lost depends on the specific form of glomerular disease.
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Acute Renal Failure (ARF): This refers to a rapid decline in kidney function, which can be life-threatening and may require dialysis to replace function. For some people, kidney function may return after the cause of the ARF has been treated without any permanent damage. However, some individuals who recover from ARF may later develop chronic kidney disease (CKD).
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Chronic Kidney Disease (CKD): This is characterized by a slight and gradual decrease in kidney function. It can take years for symptoms to emerge. Certain diseases that cause CKD can be managed, but they cannot be completely cured. Once scarring occurs in the kidneys, it cannot be reversed. CKD can eventually lead to total kidney failure.
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Total Kidney Failure: Also known as end-stage renal disease (ESRD), it signifies a permanent loss of kidney function. A person with total kidney failure requires dialysis or a kidney transplant to survive.
How Is It Treated?
Treatment of the glomerular disease depends on the underlying cause and the severity of kidney damage. It may include:
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Medications to control symptoms, manage complications, and treat underlying conditions.
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Lifestyle changes include following a low-protein diet, controlling blood pressure, avoiding nephrotoxins, and maintaining a healthy weight.
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Dialysis or kidney transplant for end-stage renal disease (ESRD) when the kidneys can no longer function effectively.
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Kidney-sparing treatments, such as plasma exchange or immunosuppressive therapy, slow down the progression of some autoimmune kidney diseases.
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Management of complications such as anemia, bone disease, and electrolyte imbalances.
What Is the Prognosis?
If a person is diagnosed with glomerular disease, the best outcome is possible with an early diagnosis and treatment. Treatment aims to prevent or slow down the worsening of kidney damage. If the damage worsens and results in kidney failure, dialysis or a kidney transplant are the only options.
Conclusion
Glomerular disease refers to conditions that harm the glomeruli, the tiny filters in the kidneys, causing them to become damaged and not work properly. This can lead to serious kidney damage and, in extreme cases, kidney failure. Glomerular disease can stem from various causes, including infections, autoimmune disorders, hereditary factors, drug toxicity, degenerative conditions, and trauma. Symptoms may include frothy urine, swelling, high blood pressure, dark urine, fatigue and weakness, decreased urine production, blood in urine, and abdominal pain. Diagnosis of the glomerular disease involves a thorough medical examination and tests like urinalysis, blood tests, imaging tests, and kidney biopsy. Without proper treatment, the glomerular disease can lead to either sudden renal failure or a gradual decrease in kidney function.
