Glomerular diseases affect the tiny filters in the kidneys, called glomeruli, and can lead to protein or blood in the urine, swelling and loss of kidney function. Early diagnosis, often with a kidney biopsy, allows targeted treatment. Dr. Satarupa Deb manages glomerular diseases at Bombay Hospital, South Mumbai.
What Are Glomerular Diseases?
Each kidney contains around a million glomeruli that filter the blood. When these filters are inflamed or scarred, they may leak protein and red blood cells into the urine and filter waste less effectively.
Glomerular diseases usually present in two broad patterns. Nephrotic syndrome involves heavy protein loss, low blood albumin and swelling. Nephritic syndrome, or glomerulonephritis, involves blood in the urine, high blood pressure and often reduced kidney function. Some conditions show features of both.
Types and Causes
Glomerular diseases may be primary, affecting only the kidney, or secondary to a condition elsewhere in the body.
- IgA nephropathy
- Minimal change disease and focal segmental glomerulosclerosis (FSGS)
- Membranous nephropathy
- Lupus nephritis and vasculitis
- Post-infectious glomerulonephritis, and glomerular disease linked to hepatitis B, hepatitis C or HIV
- Diabetic and inherited conditions such as Alport syndrome
Symptoms
Symptoms depend on the type and severity of disease, and some people have none at all. Possible signs include:
- Frothy urine
- Pink, red or cola-coloured urine
- Swelling of the face, legs or abdomen
- New or worsening high blood pressure
- Reduced urine output, tiredness or breathlessness
Diagnosis
Evaluation begins with urine and blood tests, followed in many cases by a kidney biopsy, which is often the most reliable way to identify the exact disease and plan treatment.
- Urine microscopy and urine protein-to-creatinine ratio
- Blood creatinine, albumin, cholesterol and blood counts
- Immunological tests such as ANA, complement levels, ANCA and anti-PLA2R antibodies where relevant
- Tests for hepatitis B, hepatitis C and HIV
- Kidney ultrasound and kidney biopsy
Treatment of Glomerular Disease
Treatment is tailored to the specific diagnosis, following international (KDIGO) guidance. Supportive care for most patients includes blood pressure control, medicines that reduce protein leakage, a low-salt diet, managing swelling with diuretics and treating high cholesterol.
Many glomerular diseases also need medicines that calm the immune system, such as steroids or other immunosuppressive drugs. These require careful monitoring for side effects and infections. Secondary causes, such as infections or lupus, are treated alongside the kidney disease.
Treatment of glomerular disease is often long term and may involve periods of remission and relapse. Regular follow-up with urine and blood tests allows your nephrologist to adjust medicines, watch for side effects such as infections, raised blood sugar or bone thinning, and make sure vaccinations are up to date where appropriate.
When to See a Nephrologist
See a nephrologist if you have persistent protein or blood in your urine, unexplained swelling, a rise in creatinine, or if you have lupus or another autoimmune disease with abnormal urine tests. Early treatment may help preserve kidney function.
Frequently Asked Questions
Is a kidney biopsy safe?
A kidney biopsy is a commonly performed procedure done under local anaesthesia with ultrasound guidance. Like any procedure it carries some risks, mainly bleeding, which your doctor will explain and take steps to minimise.
Can glomerular disease be cured?
Some forms, such as minimal change disease, often respond well to treatment and may go into remission, although relapses can occur. Others are managed long term with the aim of slowing progression.
Are steroids always needed?
No. Whether steroids or other immunosuppressive medicines are needed depends on the exact diagnosis, the amount of protein loss and kidney function. Some patients are managed with supportive care alone.
Can glomerular disease come back after a kidney transplant?
Certain glomerular diseases, such as FSGS and IgA nephropathy, can recur in a transplanted kidney. Your nephrologist will discuss this risk and monitoring plan if transplant is being considered.
Consult Dr. Satarupa Deb
If you have been diagnosed with or suspect a glomerular disease, book a consultation with Dr. Satarupa Deb at Bombay Hospital, South Mumbai, for expert diagnosis and treatment.
This page is for general information only and is not a substitute for a medical consultation. Please consult a qualified doctor for diagnosis and treatment.