Glomerular Disease

If normal functioning of kidneys is affected, it results in Glomerular Disease. In this disease, a particular part of the kidney called Glomeruli is affected. Healthy kidneys excrete toxins and waste in the urine while retaining red blood cells and proteins in the blood. However, in Glomerular Disease, toxins are retained in the blood in glomeruli, while red blood cells and proteins are filtered out in the urine. Glomerular disease can be of two types:

1. Glomerulonephritis: In this case, blood in the urine and swelling of glomeruli is seen.
2. Glomerulosclerosis: It is caused due to scarring of glomeruli and in turn results in washing away of the protein in the urine. It is characterised by Glomerulus hardening.

Glomerular Disease may be caused due to the following reasons:

1. Infections like Post Streptococcal Glomerulonephritis, Viral Kidney Infection or Human Immunodeficiency Virus.
2. Autoimmune diseases like Lupus, Goodpasture’s Syndrome and IgA Nephropathy.
3. Inflammation of blood vessels, also called Vasculitis. Different types of Vasculitis Like Polyarteritis and Granulomatosis with Polyangiitis.
4. Sclerotic conditions can also cause Glomerular Disease; it includes:
   1. Diabetes Nephropathy: Damage to blood vessels present in kidneys due to uncontrolled Diabetes. 
   2. IgA Nephropathy 
   3. High Blood Pressure
5. Genetic Factors
6. Cryoglobulinemia: Increased proteins in the blood
7. Cancer

The following are the risk factors for Glomerular Disease:

1. Old age
2. High blood pressure
3. Obesity
4. High blood sugar levels
5. Family history of kidney disorders
6. Heart disorders

1. Blood in the urine
2. Protein in urine
3. Retention of fluid or oedema
4. Inflammation in the lower leg, face, foot, and abdomen
5. Tiredness
6. Less frequent urination
7. Increased Blood Pressure

The test to diagnose Glomerular Disease includes:

1. Blood tests: Tests are performed to determine blood urea nitrogen and creatinine levels, which rise when the kidneys are damaged and no longer filter the blood properly. Blood testing can also detect underlying conditions like Diabetes, Autoimmune diseases like Lupus or any Infections.
2. Urine tests: These are performed to detect the number of red blood cells, white blood cells, or protein levels.
3. Imaging tests: Ultrasound is performed to diagnose the shape of kidneys in Glomerular Disease. 
4. Kidney biopsy: A biopsy is performed to confirm a diagnosis and determine the extent and type of tissue damage.

Depending upon the type, underlying cause, and severity, treatment is provided for Glomerular Disease.

1. If Glomerular Disease is inherited, then treatment includes:
   1. Alport Syndrome: Chronic glomerular disease, along with hearing and vision loss, are symptoms of this genetic disorder. Blood pressure medicines are used for the treatments.
2. If Glomerular Disease is caused due to Autoimmune disorders, then treatment includes:
   1. Systemic Lupus Erythematosus: Lupus nephritis, or inflammation of the glomeruli, develops in the kidney. Scarring results from inflammation, which prevents the kidney from functioning normally. Immunosuppressive drugs like Cyclophosphamide, combined with the Corticosteroid Prednisolone or Mycophenolate Mofetil, are used to treat inflammation.
   2. Goodpasture’s Syndrome: The kidneys and lungs are attacked by this autoimmune disease. It causes glomerulonephritis in the kidney, which is an inflammation of the glomeruli that results in permanent kidney injury. Immunosuppressive medications and Plasmapheresis are two options for treatment.
   3. IgA Nephropathy: Antibody immunoglobulin A (IgA) creates deposits in the Glomeruli in this autoimmune disorder. These deposits cause inflammation. Angiotensin-converting enzyme inhibitors or Angiotensin receptor blockers are used as treatment options for IgA Nephropathy.
3. If Infection causes Glomerular Disease, then treatment includes:
   1. Acute Post Infectious Glomerulonephritis: This glomerular condition develops after an infection such as strep throat or impetigo. To resist the infection, the immune system overproduces antibodies, which settle in the glomeruli and cause damage. In most cases, no therapy is required. Kidney dialysis or transplantation may be required in some circumstances.
   2. Viruses: Human Immunodeficiency Virus, Hepatitis B, and Hepatitis C may cause Glomerular Disease. Treatment is provided according to Virus that has caused the infection.
4. If  Sclerotic Disease causes Glomerular Diseases, then treatment includes:
   1. Diabetic Nephropathy: It causes kidney scarring and increases blood glucose levels. Glucose increases blood flow into the kidney, burdening the glomeruli's filtering function and results in raising the blood pressure. Blood pressure medications like Angiotensin-Converting Enzyme inhibitors or Angiotensin Receptor Blockers, exercise, and a healthy diet are standard therapies.
   2. Focal Segmental Glomerulosclerosis: This is caused by scarring in one area of the glomerulus. The goal of treatment is to lower blood pressure and cholesterol.
5. If Glomerular Disease results in Total Kidney failure, then treatment includes Dialysis

1. Increased blood pressure can be caused by inflammation or scarring of the glomeruli.
2. Nephrotic syndrome is characterised by an excess of blood protein in the urine and an insufficient amount in the bloodstream.
3. Waste or toxins build up in the bloodstream.
4. Loss of red blood cells and blood proteins.
5. Poor regulation of vital minerals and nutrients.
6. Acute or Chronic kidney failure.

Disease Progression

Glomerular filtration rate measures the amount of blood passing through glomeruli. Glomerular Disease progresses when the glomerular filtration rate declines, leading to chronic kidney disease and end-stage renal disease. 

Stages of Glomerular Disease include:

1. Primary Glomerular Disease: This disease occurs without the presence of another systemic disease like diabetes etc.
2. Secondary Glomerular Disease: This disease occurs due to underlying systemic causes like Diabetes, Hypertension, etc.