Glomerular disease is a disorder of the kidneys, in which the normal functioning of the kidneys is affected and the chemical balance is not maintained in the blood and urine no more. Healthy kidneys flush out toxins and waste materials in the urine and keep red blood corpuscles and proteins in the blood itself because these are not filtered out. But in the case of glomerular disease, toxins are retained in the blood, whereas red blood corpuscles and proteins get filtered out into the urine. This disorder can be either acute – means sudden or rapid occurrence or can be chronic – means it builds up over a period slowly.
What are the signs & symptoms of glomerular diseases?
The signs and symptoms of glomerular disease are as following:
- Albuminuria: Presence of large amounts of protein in the urine
- Hematuria: Presence of blood in the urine
- Reduced glomerular filtration rate: Inefficiency in filtering of waste materials from the blood
- Hypoproteinemia: Presence of low blood protein
- Edema: Presence of swelling in many different parts of the body
One or more of these symptoms can be present together & also can be the first sign of kidney disease. But some of these symptoms shows different signs, or visible manifestations:
- Proteinuria may cause formation of foamy urine.
- Blood may cause the urine to become pink or cola-colored.
- Edema may be usually present in hands and ankles, especially at the end of the day i.e., evening, or around the eyes when awakening in the morning, for example.
What are the causes of glomerular diseases?
- Nephritis–red blood cell (RBC): It can be both chronic and acute in nature.
- Nephrosis–proteinuria: It can be both chronic and acute in nature. Excretion of protein in the urine decreases the protein content in the blood and can lead to edema development or fluid retention in the abdomen (ascites) or lung spaces (pleural effusion).
- Intrinsic tubular disease: The tubule, which along with the glomerulus, makes up the nephron unit, can undergo acute tubular necrosis (ATN), normally due to drug toxicity, cardiac surgery. ATN causes significant kidney injury.
- Obstructive nephropathy: Obstruction anywhere in the urinary tract can cause the stoppage of urine above the level of obstruction, decreasing glomerular filtration. Stones, prostate surgery, metastatic cancer, or unknown surgical damage (suturing the ureter) can cause obstructive nephropathy.
- Liver diseases: Like portal hypertension.
What are the risk factors of glomerular diseases?
The risk factors for glomerular disease are as following:
- Kidney diseases and infections
- High blood pressure
- Age above 65
What are the ways to diagnose glomerular diseases?
After a thorough physical and medical history, a healthcare provider will recommend few tests, as following:
- Urine test (urinalysis), to examine for high protein level, presence of red blood cells, and white blood cell level (would indicate infection or inflammation).
- Blood tests, to examine for low protein level, creatinine (kidney function) and urea nitrogen levels (waste product). A calculation is made, called the glomerular filtration rate (GFR), to determine if a person’s kidneys are filtering properly or not.
If these lab tests indicate kidney any damage, a healthcare provider may recommend:
- Additional blood tests for some different causes such as infections or autoimmune diseases.
- Imaging tests, including ultrasound, to see whether the shape or size of the kidneys is abnormal or not.
- Kidney biopsy involves using a needle to remove small pieces of tissue to examine under a microscope.
How do glomerular diseases interfere with other kidney functions?
Glomerular diseases damage the glomeruli, allowing protein and sometimes red blood cells leak into the urine. Sometimes a glomerular disease also causes disturbance with the clearance of waste products by the kidney, so they accumulate to build up in the blood. Furthermore, loss of blood proteins like albumin in the urine can result in a fall in protein level in the bloodstream. In normal blood, albumin works as a sponge, absorbing extra fluid from the body into the bloodstream, where it remains until the kidneys remove it from the blood. But sometimes when albumin leaks into the urine, the blood loses its capacity to absorb extra fluid from the body. Fluid starts to accumulate outside the circulatory system in the face, hands, feet, or ankles and which causes swelling or edema.
How many chances are there of glomerular disease resulting in kidney failure?
If a person ‘s kidneys cannot excrete waste products in the blood, waste products will accumulate. This accumulation can damage the kidneys and cause loss of function. The loss of function can be acute (rapid) or slow and ongoing (chronic). Depending on the type of glomerular disease, renal function may be lost within a few days or weeks or may be lost slowly over decades.
- Acute renal failure (ARF): This is a fast loss of kidney function. ARF can become life-threatening and may require emergency care alongwith with dialysis to replace renal function. In some people, kidney function returns after the cause of the kidney failure has been treated. There is no permanent damage. However, some people who recover from ARF may develop chronic kidney disease.
- Chronic kidney disease (CKD): This is a slow, progressive loss of kidney function. Person may not have symptoms for the next many years. Some diseases that cause CKD can be slowed down , but CKD can’t be cured permanently. Mostly CKD may lead to total kidney failure.
- Total kidney failure: Total kidney failure, also called end-stage renal disease (ESRD), means permanent loss of kidney functions. If there is total renal failure, a person needs dialysis (hemodialysis or peritoneal dialysis) or a kidney transplant to stay alive and healthy.
What are the treatments available for glomerular diseases?
Immunosuppressant medicines like some steroids are used for treating glomerular disease. If the disease is rapidly progressive, plasmapheresis is used to eliminate blood components which are responsible for inflammation.
- High blood pressure management
Management of high blood pressure is important to reduce the damages in the kidneys. Therefore, drugs are recommended to decrease the amount of proteins in urine and to decrease the progression of glomerular disease.
If remain untreated, glomerular disease could lead to other complications such as high blood pressure, acute kidney failure, chronic kidney failure and nephrotic syndrome. Acute kidney failure is most likely to occur along with acute glomerulonephritis. If glomeruli are not capable of filtering out waste, toxins accumulate in blood. In such cases, hemodialysis may be required to remove toxins from blood manually. This could be advised as a temporary method until the kidneys are restored to their original functionality, or be a permanent one in case the damages to the kidney are too severe which can’t be treated.
- Kidney transplantation
If the functionality of the kidneys is not under restoration, then a nephrologist may suggest a kidney transplantation surgery. In this process, a healthy kidney from a donor is transplanted into a patient by surgical methods.
What are the preventive measures for glomerular diseases?
Person can make lifestyle changes to remain healthy to reduce the risk of developing other diseases that affect the kidneys. These changes mainly include:
- Maintain a healthy weight.
- Keeping the salt intake low; don’t add extra salt to the foods.
- Keep the blood pressure under control. Keep target at 120/80 mmHg.
- Control the blood sugar if a person has diabetes. Take all the prescribed medications and follow all management goals discussed with the doctor.
- Stop smoking.
It is almost impossible to prevent all the causes of glomerular disease. However, as soon as a person notices signs of glomerular disease, vist a healthcare provider. It’s important to find treatable causes of disease and to start suitable treatment as soon as possible. Treatments may slow down the kidney damage and/or prevent it from getting worse further.