From the Guidelines
Glomerulosclerosis is a condition characterized by scarring and hardening of the glomeruli, which are the tiny blood vessel clusters in the kidneys that filter waste from the blood, as noted in the 2021 KDIGO clinical practice guideline for the management of glomerular diseases 1. This scarring process damages the filtering function of the kidneys, potentially leading to kidney failure over time. Glomerulosclerosis can occur as a primary kidney disease or secondary to other conditions like diabetes (diabetic nephropathy) or hypertension. The condition develops when the glomeruli become inflamed or damaged, triggering a healing process that results in scar tissue formation. As scarring progresses, kidney function gradually declines, causing symptoms such as protein in the urine (proteinuria), high blood pressure, and swelling in the legs and feet (edema). Treatment typically focuses on controlling the underlying cause, such as managing blood sugar in diabetes or lowering blood pressure with medications like ACE inhibitors or ARBs, as recommended by the KDIGO guideline 1. These medications help reduce pressure within the glomeruli and decrease protein leakage. Additional treatments may include dietary modifications to reduce sodium and protein intake, along with medications to control cholesterol and reduce inflammation. Early detection through regular kidney function tests is crucial, as treatment can slow progression even though the scarring itself is generally irreversible, as highlighted in the executive summary of the KDIGO 2021 guideline for the management of glomerular diseases 1. It is essential to note that the management of glomerular diseases, including glomerulosclerosis, should be based on the latest evidence-based recommendations, such as those provided by the KDIGO guideline, to improve patient outcomes and reduce morbidity and mortality 1. Some key points to consider in the management of glomerulosclerosis include:
- Controlling the underlying cause of the condition, such as diabetes or hypertension
- Using medications like ACE inhibitors or ARBs to reduce pressure within the glomeruli and decrease protein leakage
- Implementing dietary modifications to reduce sodium and protein intake
- Using medications to control cholesterol and reduce inflammation
- Regular monitoring of kidney function to detect any changes or progression of the disease. The KDIGO guideline provides a comprehensive framework for the management of glomerular diseases, including glomerulosclerosis, and should be consulted for detailed recommendations and practice points 1.
From the Research
Definition of Glomerulosclerosis
Glomerulosclerosis refers to the scarring or hardening of the glomeruli, which are the blood vessels in the kidneys that filter waste and excess fluids from the blood.
Causes and Progression
- Glomerular diseases may progress to end-stage renal failure via the development of glomerulosclerosis 2.
- Systemic hypertension and intraglomerular hypertension are important determinants of this process 2.
- Proteinuria (albuminuria) is a surrogate marker for glomerular damage and renal prognosis 2.
Treatment and Management
- Angiotensin-converting enzyme (ACE) inhibitors have been shown to be effective in reducing proteinuria and preventing glomerulosclerosis or progression to end-stage renal failure 2, 3, 4, 5.
- Calcium channel blockers may also be effective in reducing proteinuria and attenuating the progression of glomerulosclerosis, although their effect is less uniform 2, 6.
- The combination of an ACE inhibitor and a calcium channel blocker may be a promising approach in reducing glomerulosclerosis 2.