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Patient education: Glomerular disease (Beyond the Basics)

Patient education: Glomerular disease (Beyond the Basics)
Author:
Ronald J Falk, MD
Section Editors:
Richard J Glassock, MD, MACP
Brad H Rovin, MD
Deputy Editor:
Albert Q Lam, MD
Literature review current through: Nov 2022. | This topic last updated: Apr 21, 2022.

GLOMERULAR DISEASE OVERVIEW — Glomerular disease reduces the kidneys' ability to maintain a balance of certain substances in bloodstream. Normally, the kidneys filter toxins out of the bloodstream and excrete them in the urine but keep red blood cells and protein in the bloodstream. In people with glomerular disease, red blood cells and protein may be excreted into the urine, while toxins may be retained.

Glomerular disease can occur by itself (ie, affect only the kidney) or may be associated with an underlying medical condition that affects other organ systems, such as lupus, diabetes, or certain infections. Glomerular disease can develop suddenly ("acute" glomerular disease) or develop slowly over a period of years ("chronic" glomerular disease). Treatment of glomerular disease depends upon its cause and type.

NORMAL KIDNEY FUNCTION — To understand glomerular disease, it may be helpful to understand how the kidneys normally function. The kidneys are bean-shaped, approximately fist-sized organs that are located in the mid-back, just below the rib cage on each side of the body.

The kidneys filter the body's blood supply with tiny structures, known as nephrons. Each kidney contains hundreds of thousands of nephrons. Each nephron is composed of a glomerulus and a tubule (figure 1). The glomerulus filters wastes and excess fluids, while the tubules modify the waste to form urine. Glomerular disease affects the glomerulus, causing it to filter and excrete incorrectly.

GLOMERULAR DISEASE FEATURES — Signs and symptoms of glomerular disease depend upon the cause. The first sign of a problem may be a urine test (urinalysis) that comes back abnormal after being done for another reason. The urinalysis may detect:

More red blood cells than normal – In addition to showing up on urinalysis, this sometimes causes the urine to look light or dark brown in color. The medical term for blood in the urine is "hematuria." (See "Patient education: Blood in the urine (hematuria) in adults (Beyond the Basics)".)

More protein than normal – The medical term for this is "proteinuria." (See "Patient education: Protein in the urine (proteinuria) (Beyond the Basics)".)

Signs and symptoms may also include an elevated blood pressure (greater than 130/80 mmHg); fluid retention (edema) in the hands, face, feet, and/or abdomen; fatigue (due to anemia or kidney failure); or urinating infrequently. (See "Patient education: Edema (swelling) (Beyond the Basics)".)

TYPES OF GLOMERULAR DISEASE — The two basic types of glomerular disease include nephritic and nephrotic, but, with some diseases, the two types can overlap. (See "Glomerular disease: Evaluation and differential diagnosis in adults".)

Nephritic — The key feature of nephritic disease ("glomerulonephritis") is blood in the urine (hematuria). In milder disease, there may not be significant impairment of kidney function or proteinuria. In fact, a person with glomerulonephritis may not have any symptoms, and their condition may go unnoticed until blood and protein are found during a routine urinalysis. People with more severe nephritic disease have hematuria and, often, impaired kidney function. Urine testing may also show high levels of protein, and the person may have edema (swelling in the lower legs) or high blood pressure.

Examples of conditions that may cause glomerulonephritis include:

Immunoglobulin A (IgA) nephropathy

Lupus

Vasculitis

Certain bacterial and viral infections (postinfectious glomerulonephritis)

Mixed cryoglobulinemia

Membranoproliferative glomerulonephritis

Alport syndrome

IgA vasculitis (Henoch-Schönlein purpura)

C3 glomerulopathy

Nephrotic syndrome — People with nephrotic syndrome have protein in the urine (proteinuria) but, often, little to no blood in the urine (hematuria). Kidney function may worsen as nephrotic syndrome progresses. (See "Patient education: The nephrotic syndrome (Beyond the Basics)".)

Examples of conditions that may cause nephrotic syndrome include:

Minimal change disease

Focal segmental glomerulosclerosis

Membranous nephropathy (including lupus)

Diabetic nephropathy

Postinfectious glomerulonephritis (later stage)

IgA nephropathy

Primary amyloidosis or the related disorder light chain deposition disease

GLOMERULAR DISEASE DIAGNOSIS — Glomerular disease is diagnosed based on the results of blood or urine tests. Other tests, including imaging tests and/or kidney biopsy, may be used to help diagnose the specific type of glomerular disease.

Urine tests — The urinalysis may show red blood cells (which are seen when there is damage or inflammation in the glomeruli), white blood cells (which can indicate inflammation), or increased protein levels (which is an indicator of glomerular damage).

Blood tests — Blood tests are used to measure the level of creatinine and blood urea nitrogen (BUN), which become elevated when the kidneys are damaged and are not filtering properly. Blood tests may also be used to diagnose underlying medical conditions (such as diabetes, lupus, or certain infections).

Imaging tests — An ultrasound of the kidney is frequently recommended if glomerular disease is suspected, primarily to rule out other causes of blood in the urine and/or decreased kidney function. The ultrasound can also measure the size of the kidneys, which can provide a clue as to the duration of the kidney disease.

Kidney biopsy — A kidney (renal) biopsy may be needed to definitively determine the cause of glomerular disease in patients that cannot be diagnosed by blood tests or imaging tests alone. A separate topic review discusses renal biopsy. (See "Patient education: Kidney (renal) biopsy (Beyond the Basics)".)

GLOMERULAR DISEASE TREATMENT — The treatment of glomerular disease depends upon the form (acute or chronic), the underlying cause, and the severity of associated signs and symptoms. Some forms of glomerular disease, such as that caused by infection, improve after the infection is treated.

Other types of glomerular disease may require treatment with medications that suppress the immune system, such as glucocorticoids (commonly called steroids). Cyclophosphamide (brand name: Cytoxan), rituximab (brand name: Rituxan), azathioprine (sample brand names: Azasan, Imuran), or mycophenolate mofetil (brand name: Cellcept) may be used as well. Rapidly progressive glomerulonephritis is sometimes treated with plasmapheresis, a procedure to filter the blood and remove substances that could be causing the inflammation.

Some forms of glomerular disease do not require treatment, while others do not respond to any therapy.

Managing high blood pressure — Management of high blood pressure is important to prevent further damage to the kidneys; one or more medications may be needed. One or more high blood pressure medications may be recommended for patients with chronic glomerular disease to decrease the amount of protein in the urine and slow the rate of progression of kidney disease. (See "Patient education: High blood pressure treatment in adults (Beyond the Basics)" and "Patient education: High blood pressure, diet, and weight (Beyond the Basics)".)

GLOMERULAR DISEASE COMPLICATIONS — Some types of glomerular disease are associated with complications, including high blood pressure, acute or chronic kidney failure, and nephrotic syndrome. (See "Patient education: The nephrotic syndrome (Beyond the Basics)".)

High blood pressure — High blood pressure can develop in people with glomerular disease due to kidney damage and buildup of waste products and excess fluid in the bloodstream. One or more medications may be needed to reduce blood pressure and prevent further damage to the kidneys. (See "Patient education: High blood pressure treatment in adults (Beyond the Basics)".)

Acute kidney failure — Sudden onset (acute) kidney failure is more likely to occur with acute glomerulonephritis (eg, diffuse nephritic). If the glomeruli are unable to filter the blood adequately, waste products and excess fluids build up in the bloodstream quickly. Hemodialysis may be needed to remove waste products and excess fluids. This could be temporary, until the kidney function recovers, or may be long term if the kidneys become damaged. (See "Patient education: Hemodialysis (Beyond the Basics)".)

Chronic kidney failure — If kidney function continues to worsen, dialysis or kidney transplantation may be needed to perform the normal functions of the kidneys. There are two types of dialysis: hemodialysis and peritoneal dialysis. (See "Patient education: Hemodialysis (Beyond the Basics)" and "Patient education: Peritoneal dialysis (Beyond the Basics)".)

WHERE TO GET MORE INFORMATION — Your healthcare provider is the best source of information for questions and concerns related to your medical problem.

This article will be updated as needed on our web site (www.uptodate.com/patients). Related topics for patients, as well as selected articles written for healthcare professionals, are also available. Some of the most relevant are listed below.

Patient level information — UpToDate offers two types of patient education materials.

The Basics — The Basics patient education pieces answer the four or five key questions a patient might have about a given condition. These articles are best for patients who want a general overview and who prefer short, easy-to-read materials.

Patient education: Chronic kidney disease (The Basics)
Patient education: Glomerular disease (The Basics)
Patient education: Cadmium toxicity (The Basics)
Patient education: Paget disease of bone (The Basics)

Beyond the Basics — Beyond the Basics patient education pieces are longer, more sophisticated, and more detailed. These articles are best for patients who want in-depth information and are comfortable with some medical jargon.

Patient education: Blood in the urine (hematuria) in adults (Beyond the Basics)
Patient education: Protein in the urine (proteinuria) (Beyond the Basics)
Patient education: Edema (swelling) (Beyond the Basics)
Patient education: The nephrotic syndrome (Beyond the Basics)
Patient education: Kidney (renal) biopsy (Beyond the Basics)
Patient education: High blood pressure treatment in adults (Beyond the Basics)
Patient education: High blood pressure, diet, and weight (Beyond the Basics)
Patient education: Hemodialysis (Beyond the Basics)
Patient education: Peritoneal dialysis (Beyond the Basics)

Professional level information — Professional level articles are designed to keep doctors and other health professionals up-to-date on the latest medical findings. These articles are thorough, long, and complex, and they contain multiple references to the research on which they are based. Professional level articles are best for people who are comfortable with a lot of medical terminology and who want to read the same materials their doctors are reading.

Diagnostic approach to adult patients with subacute kidney injury in an outpatient setting
Glomerular disease: Evaluation and differential diagnosis in adults
Etiology and evaluation of hematuria in adults
Assessment of urinary protein excretion and evaluation of isolated non-nephrotic proteinuria in adults
Mechanisms of immune injury of the glomerulus

The following organizations also provide reliable health information.

National Library of Medicine

     (https://medlineplus.gov/healthtopics.html)

National Institute of Diabetes and Digestive and Kidney Diseases

     (https://www.niddk.nih.gov/)

National Kidney Foundation

     (https://www.kidney.org/)

American Kidney Fund

     (https://www.kidneyfund.org/)

American Association of Kidney Patients

     (https://aakp.org/)

This generalized information is a limited summary of diagnosis, treatment, and/or medication information. It is not meant to be comprehensive and should be used as a tool to help the user understand and/or assess potential diagnostic and treatment options. It does NOT include all information about conditions, treatments, medications, side effects, or risks that may apply to a specific patient. It is not intended to be medical advice or a substitute for the medical advice, diagnosis, or treatment of a health care provider based on the health care provider's examination and assessment of a patient's specific and unique circumstances. Patients must speak with a health care provider for complete information about their health, medical questions, and treatment options, including any risks or benefits regarding use of medications. This information does not endorse any treatments or medications as safe, effective, or approved for treating a specific patient. UpToDate, Inc. and its affiliates disclaim any warranty or liability relating to this information or the use thereof. The use of this information is governed by the Terms of Use, available at https://www.wolterskluwer.com/en/know/clinical-effectiveness-terms ©2023 UpToDate, Inc. and its affiliates and/or licensors. All rights reserved.
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