How many have glomerular disease?
The prevalence of glomerular diseases in the general population is difficult to evaluate as optimal conditions for performing epidemiologic surveys are difficult to find. However, recent studies from Europe and Australia have suggested a change in the pattern of glomerular diseases in the community where focal segmental glomerulosclerosis is increasing in incidence in the black and Hispanic population. Glomerular disease are an important cause of acute kidney injury (AKI) and they account for approximately 15% of end-stage renal disease (ESRD).
How is glomerular disease treated?
As with general CKD, the first step in treating glomerular disease is to control hypertension. In infectious diseases, treatment aims to remove the infectious agent. In autoimmune diseases, immunosuppressive drugs and “blood-cleaning therapy” (plasmapheresis) are utilized to remove autoantibodies. Some patients are treated with corticosteroid therapy (e.g. minimal change disease and lupus nephritis). In patients experiencing swelling due to changes in fluid homeostasis, diuretics are recommended. With good management of hypertension and other underlying disease drivers, kidney dysfunction and other complications can be prevented or delayed. Due to the reservoir of nephrons, patients are usually diagnosed when the disease is already advanced. Patients that reach end-stage kidney disease require dialysis or kidney transplantation.
What are the symptoms of glomerular disease, and how is it diagnosed?
The signs and symptoms of glomerular disease include
- albuminuria: large amounts of protein in the urine
- hematuria: blood in the urine
- reduced glomerular filtration rate: inefficient filtering of wastes from the blood
- hypoproteinemia: low blood protein
- edema: swelling in parts of the body
One or more of these symptoms can be the first sign of kidney disease.
Patients with glomerular disease have significant amounts of protein in the urine, which may be referred to as "nephrotic range" if levels are very high. Red blood cells in the urine are a frequent finding as well, particularly in some forms of glomerular disease. Urinalysis provides information about kidney damage by indicating levels of protein and red blood cells in the urine. Blood tests measure the levels of waste products such as creatinine and urea nitrogen to determine whether the filtering capacity of the kidneys is impaired. If these lab tests indicate kidney damage, the doctor may recommend ultrasound or an x-ray to see whether the shape or size of the kidneys is abnormal. These tests are called renal imaging. But since glomerular disease causes problems at the cellular level, the doctor will probably also recommend a kidney biopsy—a procedure in which a needle is used to extract small pieces of tissue for examination with different types of microscopes, each of which shows a different aspect of the tissue. A biopsy may be helpful in confirming glomerular disease and identifying the cause.