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Health Blog :: What is a glomerular disease, and how do I know I have one?

June 21, 2021

Kidneys have about one million tiny filter units called nephrons. Each nephron has a glomerulus and tubule. Blood passes through these million glomeruli and each glomerulus acts as a filter- it filters and retains the necessary components of blood such as red blood cells and proteins and drains the rest in the tubule. The tubule then fine-tunes the filtered blood further and ultimately produces urine. 

Injury to the cells of glomeruli can cause blood and protein to leak in the urine.

What are the different kinds of glomerular diseases?

Glomeruli can be affected by various diseases- some affecting the entire body such as diabetes, hypertension, or lupus, and others which affect just the kidneys such as "IgA nephropathy" or "Membranous nephropathy". Glomerular diseases that are limited to the kidneys can be caused by the deposition of certain self-generated antibodies against the cells of the glomerulus.  Occasionally the exact cause for the glomerular disease cannot be found and is called "idiopathic".

What are the symptoms of glomerular disease?

Symptoms or signs of glomerular disease can include one or more of the following:

Blood in the urine (hematuria): Your urine may look pink or red depending on how much blood is present. Sometimes, the blood in the urine may be in very tiny amounts called microscopic hematuria and may not be visible to the naked eye. This can be detected by a routine urine test.

Protein in the urine (proteinuria): Glomerular disease can cause protein to leak in the urine. Your urine may become foamy because of the protein.

Swelling: Glomerular disease can cause fluid to build up in various parts of your body and cause swelling in your legs or around your eyes.

Kidney failure: Glomerular diseases can cause acute kidney failure which can sometimes rapidly progress as well as chronic kidney failure, both of which may be severe enough to require dialysis. Kidney function can be tested with a simple blood test.

What tests will I need to perform?

If you have any of the above symptoms or signs suggestive of glomerular disease, you should be evaluated by a kidney specialist. Tests that are ordered for further evaluation include blood tests to assess kidney function, tests of various inflammatory markers and antibodies, urine tests to detect and determine how much blood and protein is present in the urine, and kidney ultrasound. Frequently a kidney biopsy is required to ascertain the exact diagnosis of glomerular disease.

A kidney biopsy is a procedure in which a few very small pieces of the kidney are taken with a special long needle and sent to a pathology laboratory to determine the cause of glomerular injury. This procedure is performed in the hospital under real-time guidance from a kidney ultrasound or a CT scan and is usually done under local anesthesia and with minimal sedation.

What is the treatment of the glomerular disease?

Treatment of glomerular disease includes treatment of the disease itself and combating the symptoms of the disease.

You may require medications to lower your blood pressure and water pills to decrease the amount of swelling. You may also need steroids and other immunosuppressant medications to suppress the inflammatory cells causing glomerular disease.

Occasionally, the glomerular disease is from an infection or other health issues such as diabetes or cancer in which case the treatment is guided towards the broader disease which in turn fixes the problem with the glomeruli and the kidney. Sometimes despite aggressive treatment, the kidney function is bad enough that the patient might need dialysis to remove the extra fluid and toxins that build up due to the failing kidneys and may not recover even with treatment leaving the patient dialysis-dependent for life.

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