What is Glomerular Disease? (video/podcast)

Your kidneys are vital organs that help remove waste and excess fluid from your body to keep it functioning well. Think of them as your body’s filtration system. As blood passes through your kidneys, they flush out toxins while balancing your fluids and electrolytes, controlling blood pressure, regulating red blood cell production and supporting strong bones.

Glomerular disease is a condition that disrupts the kidneys' ability to do these tasks. Managing this condition can help protect you from kidney failure, a serious disease which can be life-threatening. In this video, San Diego Health host talks about glomerular disease with Zhabiz Solhjou, MD, a nephrologist at Scripps Clinic Rancho Bernardo.

Kidneys have about one million tiny filter units called nephrons, and each nephron has a glomerulus. Multiple glomerulus are called glomeruli. Glomerular disease refers to inflammation, and at times scarring, of the glomeruli. The disease is responsible for kidney failure in about 10% to 15% of end-stage kidney disease patients on dialysis.

There are numerous possible causes of glomerular disease, including infections and medications that may directly harm the kidneys. These are known as primary causes. Secondary causes of glomerular disease affect the whole body, such as diabetes or autoimmune diseases like lupus. Genetics may raise the risk in some cases. In others, the cause may be unknown.

Some glomerular disease symptoms may be subtle, while others are more obvious. Early signs of glomerular disease may include:

• Blood in the urine: Damaged glomeruli may leak blood into your urine, known as hematuria. This may cause your urine to appear pinkish or light brown.
• Protein in the urine: Proteinuria, or protein in the urine, may cause it to look foamy.
• Edema: Edema occurs when excess fluid builds up in the body and causes swelling of the legs, ankles, hands or eye area.
• High blood pressure: Hypertension may be a sign of kidney disease.

Several tests may be used to diagnose glomerular disease. The first step may be a urine test to check for blood or protein in the urine, followed by an ultrasound exam or CAT scan of the kidneys.

“Different glomerular diseases affect different patient age ranges. Some of them present themselves early on, some even at childhood,” explains Dr. Solhjou. “The most common glomerular disease, called IgA nephropathy, commonly affects patients in their twenties or early thirties, and some affect people later in life.”

Blood tests help determine which type of glomerular disease a patient may have; commonly, a kidney biopsy is needed to confirm the diagnosis.

Once the diagnosis is confirmed, treatment aims to help control symptoms, avoid complications and slow down kidney damage. Without treatment, glomerular disease typically leads to end-stage kidney disease.

There is no single treatment for glomerular disease. Each patient’s treatment plan will depend on the type of disease they have. If the cause is an underlying condition like diabetes, getting that under control is important. Medications can help control blood pressure, stop protein loss in the urine and reduce swelling. Your doctor also may recommend lifestyle and dietary changes.

“In our glomerular disease clinic at Scripps, we provide subspecialty care to patients suffering from this disease,” says Dr. Solhjou. “We have a broad range of medications to offer, as well as clinical trials for some of these conditions.”

Most glomerular diseases cannot be prevented; however, lifestyle modifications can play an important role in preventing declining kidney function. These may include losing weight, managing chronic diseases, controlling blood pressure, exercising and quitting smoking.

“These can all impact the kidneys and help lower the rate of kidney decline,” says Dr. Solhjou. “If somebody controls their risk factors very well and gets proper treatment for these conditions, we can really slow down the decline in kidney function for most of these glomerular diseases.”

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