Glomerular Diseases

There are more than 20 types of glomerular diseases. Here are some of the most common ones treated in our practice.

There are several types of common glomerular diseases treated at our practice. They are described below.

Focal Glomerulosclerosis

My doctor tells me I have focal glomerulosclerosis. What does this mean?

Focal glomerulosclerosis describes scarring in the kidney. There are more than 20 types of glomerular diseases. These are what the words mean:

  • “Glomerulo-” refers to the clusters of tiny blood vessels in the kidneys that filter waste from the blood.
  • “Sclerosis” refers to scarring.
  • “Focal” means that only some of kidneys’ glomeruli have been damaged, while some are still normal.
  • If you have focal segmental glomerulosclerosis (FSGS), it means the scarring is more limited.

Glomerulosclerosis affects both children and adults. Males are affected slightly more often than females, and it occurs more frequently in African Americans.

What causes glomerulosclerosis?

Glomerulosclerosis is not caused by a single disease. It has several different causes. The scarring may be the result of an infection, or drug toxicity, or a disease that affects the entire body, like diabetes, HIV infection, sickle cell disease or lupus disease. Sometimes, there is no apparent associated disease or cause. There may be a genetic component in some people.

People with these conditions may develop glomerulosclerosis:

  • Glomerulonephritis, an inflammation of the glomeruli.
  • Reflux nephropathy (backward flow of the urine up to the kidney).
  • Kidney-harming chemicals or medicines that damage the glomeruli.

What are the signs and symptoms?

Early stages of glomerulosclerosis may not cause any symptoms.

Your doctor may suspect kidney disease because you develop high blood pressure or show protein in your urine.

If very large amounts of protein are lost in the urine, swelling of the ankles and eyelids may occur, because the body retains water (edema). This may also cause rapid weight gain and a make high blood pressure harder to control.

If the condition is advanced, the symptoms may be like those of kidney failure. People report fatigue, a poor appetite, headache, itchy skin, shortness of breath and/or nausea.

What tests do I need?

A blood test, urine tests, and a kidney biopsy will determine if you have glomerulosclerosis.

Blood test: Your kidney function will be evaluated using the glomerular filtration rate (GFR). Your GFR number is calculated from a math equation that considers the results from a blood test that combines your blood creatinine level, your age, gender and race. People with glomerulosclerosis can have a low GFR, as their kidney damage progresses and kidney function decreases.

Urine tests: Your doctors will order urine tests for protein or red blood cells. Having large amounts of protein appearing in the urine is common in glomerulosclerosis. Blood in the urine is a warning sign of kidney disease.

Biopsy: Having a low GFR and protein in the urine is not proof of glomerulosclerosis, though. Since these are associated with other kidney conditions, a kidney biopsy is needed to diagnose glomerulosclerosis. In this procedure, a needle is used to take a tiny sample of the kidney to examine with a microscope. The diagnosis is made from the signs of scarring seen on the kidney tissue sample.

Glomerulosclerosis can cause nephrotic syndrome. Nephrotic syndrome means very high levels of protein in the urine, low blood protein levels, high cholesterol levels, and swelling.

How are focal glomerulosclerosis and FSGS treated?

Treatments for FSGS include corticosteroids (often called “steroids”) and other immunosuppressive drugs (such as cyclosporine). These medications are used to decrease proteinuria and improve kidney function. Urine is tested for protein frequently during treatment, because having less urinary protein is a sign that the treatment is working.

Another important part of treatment is to control blood pressure and blood cholesterol levels, factors that add to the risk of complications from kidney disease. Certain blood pressure medicines, called ACE (angiotensin converting enzyme) inhibitors and ARBs (angiotensin receptor blockers), are used to reduce the protein loss and blood pressure. Diuretics are medicines that help the body get rid of excess fluid and swelling. These can be used to lower your blood pressure too.

Some diet changes may be needed, such as reducing salt and protein in your food choices to lighten the load of wastes on the kidneys.

What can I expect? Will treatment cure glomerulosclerosis?

Glomerulosclerosis is a chronic disease, because the scarred glomeruli cannot be repaired. Treatment can slow the progression of kidney disease. Everyone is different in how they respond to treatment, any complications, and the rate of disease progression. Over time, some patients with glomerulosclerosis gradually get worse until they reach kidney failure, If this occurs, they will need a kidney transplant or dialysis (hemodialysis or peritoneal dialysis) to stay alive. Some people respond well to treatment and may live with the disease for many years while being monitored for any signs of change.

Should I get ready for a kidney transplant?

You should talk with your doctor about your condition, because the progression of the disease depends on many factors. The underlying cause, your age, and your overall health affect your outcome. Patients who develop kidney failure from glomerulosclerosis can be good candidates for kidney transplants. You should know that glomerulosclerosis can recur in the transplanted kidney, but that should not discourage you from seeking a transplant.

What research is being done in this condition?

Researchers are trying to answer the many unanswered questions about this disease. They are now better able to explain what happens in the kidney during glomerulosclerosis. New drug treatments are in clinical trials. Genetic and molecular research is making progress in understanding this condition and suggesting how it could be more effectively treated.

 

Glomerulonephritis

What is glomerulonephritis?

Glomerulonephritis is a group of diseases that injure the part of the kidney that filters blood (called glomeruli). Other terms you may hear used are nephritis and nephrotic syndrome. When the kidney is injured, it cannot get rid of wastes and extra fluid in the body. If the illness continues, the kidneys may stop working completely, resulting in kidney failure.

Are there different types of glomerulonephritis?

Yes. There are two types of glomerulonephritis—acute and chronic. The acute form develops suddenly. You may get it after an infection in your throat or on your skin. Sometimes, you may get better on your own. Other times, your kidneys may stop working unless the right treatment is started quickly. The early symptoms of the acute disease are:

  • Puffiness of your face in the morning
  • Blood in your urine (or brown urine)
  • Urinating less than usual.

You may be short of breath and cough because of extra fluid in your lungs. You may also have high blood pressure. If you have one or all of these symptoms, be sure to see your doctor right away.

The chronic form may develop silently (without symptoms) over several years. It often leads to complete kidney failure. Early signs and symptoms of the chronic form may include:

  • Blood or protein in the urine (hematuria, proteinuria)
  • High blood pressure
  • Swelling of your ankles or face (edema)
  • Frequent nighttime urination
  • Very bubbly or foamy urine

Symptoms of kidney failure include:

  • Lack of appetite
  • Nausea and vomiting
  • Tiredness
  • Difficulty sleeping
  • Dry and itchy skin
  • Nighttime muscle cramps

What causes acute glomerulonephritis?

The acute disease may be caused by infections such as strep throat. It may also be caused by other illnesses, including lupus, Goodpasture’s syndrome, Wegener’s disease, and polyarteritis nodosa. Early diagnosis and prompt treatment are important to prevent kidney failure.

What causes chronic glomerulonephritis?

Sometimes, the disease runs in the family. This kind often shows up in young men who may also have hearing loss and vision loss. Some forms are caused by changes in the immune system. However, in many cases, the cause is not known. Sometimes, you will have one acute attack of the disease and develop the chronic form years later.

How is a diagnosis of glomerulonephritis made?

The first clues are the signs and symptoms. Finding protein and blood cells in your urine is another sign. Blood tests will help the doctor tell what type of illness you have and how much it has hurt your kidneys.

In some cases, a test called a kidney biopsy may be needed. In this test, a tiny piece of your kidney is removed with a special needle, and looked at under a microscope. A biopsy will help the doctor plan the best treatment for you.

Can glomerulonephritis be prevented?

Not until more is known about its causes. However, good hygiene, practicing “safe sex” and avoiding IV drugs are helpful in preventing viral infections such as HIV and hepatitis, which could lead to this illness.

If you have the chronic type of glomerulonephritis, it is very important to control your blood pressure since this may slow down kidney damage. Your doctor may tell you to eat less protein. A dietitian trained to work with kidney patients (a renal dietitian) can be very helpful in planning your diet.

What treatment is available for glomerulonephritis?

The acute form may go away by itself. Sometimes you may need medication or even temporary treatment with an artificial kidney machine to remove extra fluid and control high blood pressure and kidney failure. Antibiotics are not used for acute glomerulonephritis, but they are important in treat other forms of disease related to bacterial infection. If you illness is getting worse rapidly, you may be put on high doses of medicine that affect your immune system. Sometimes, your doctor may order plasmapheresis, a special blood filtering process to remove harmful proteins from your blood.

There is no specific treatment for the chronic form of the illness. You doctor may tell you to:

  • Eat less protein, salt and potassium
  • Control your blood pressure
  • Take diuretics (water pills) to treat puffiness and swelling
  • Take calcium supplements

Nephrotic Syndrome

What is nephrotic syndrome?

Nephrotic syndrome (also called nephrosis) happens when your kidneys start losing large amounts of protein in your urine. As your kidneys get worse, extra fluids and salt build up in your body. This causes you to have swelling (edema), high blood pressure and higher levels of cholesterol. Nephrotic syndrome may come from kidney diseases or from other illnesses such as diabetes and lupus. Some medicines, IV drug abuse and HIV (the AIDS virus) may also cause it.  Sometimes, nephrotic syndrome goes away after treatment. Other times, this condition may last for many years and eventually lead to kidney failure.

What treatment is available for nephrotic syndrome?

Your doctor may prescribe corticosteroids, such as prednisone. If prednisone does not work, your doctor may suggest other medicines that affect your immune system, such as cyclophosphamide.

Your doctor may also suggest:

  • A low salt diet
  • Diuretics (water pills)
  • Blood pressure medications.

Source: National Kidney Foundation

This material does not constitute medical advice. It is intended for informational purposes only.