From the Guidelines
Glomerular disease, also known as Glomerulopathy, is primarily caused by immune-mediated diseases, infections, drugs, or malignancy, and its symptoms include heavy proteinuria, hypoalbuminemia, and edema.
Causes of Glomerular Disease
- Immune-mediated diseases, such as IgA nephropathy, membranous nephropathy, and lupus nephritis 1
- Infections, such as infection-related glomerulonephritis 1
- Drugs, which can cause glomerular injury 1
- Malignancy, which can lead to glomerular disease 1
Symptoms of Glomerular Disease
- Heavy proteinuria, defined as ≥ 1.0 g m−2 day−1 in children and ≥ 3.5 g day−1 in adults 1
- Hypoalbuminemia, defined as < 3.0 g dl−1 in adults and < 2.5 g dl−1 in children 1
- Edema, which is commonly present in patients with nephrotic syndrome 1
- Hypercholesterolemia, which is often seen in patients with nephrotic syndrome 1 The diagnosis and management of glomerular disease can be challenging due to the lack of high-quality evidence and the rarity of these diseases 1. However, guidelines such as the KDIGO 2021 Clinical Practice Guideline for the Management of Glomerular Diseases provide recommendations for the diagnosis, prognosis, treatment, and special situations of various glomerular diseases 1.
From the Research
Causes of Glomerular Disease
- Glomerulonephritis, including many forms of vasculitis, are responsible for about 15% of cases of end-stage renal disease (ESRD) 2
- Immunologically caused vasculitis, infections, and systemic inflammatory disorders can cause glomerular disease 2, 3
- Primary glomerulopathies can arise as part of a well-defined multisystem or multi-organ disease process, or as a sole or predominant involvement of glomeruli 4
- Deposition of immune complexes, antibodies, or complement components at the subepithelial, intramembranous, or subendothelial space, and mutations in podocyte, slit diaphragm, or glomerular basement membrane proteins or enzymes are the main etiologies of glomerular alterations 5
Symptoms of Glomerular Disease
- Hematuria, proteinuria, and renal failure are common symptoms of glomerulonephritis or vasculitis 2
- Arterial hypertension, hemoptysis, arthalgias, muscle pain, palpable purpura, and constitutional signs such as fever and loss of body weight may occur concurrently 2
- Nephrotic syndrome is defined by the presence of heavy proteinuria, hypoalbuminemia, and peripheral edema 3
- Nephritic syndrome is associated with hematuria and proteinuria and abnormal kidney function and carries a poorer prognosis 3
- Podocyturia, or the presence of podocytes in the urine, is a diagnostic marker for glomerular disease 5
Classification of Glomerular Disease
- Glomerulonephritis can be classified by their clinical presentation (nephrotic, nephritic, rapidly progressive GN, chronic GN) or by histopathology 3
- Primary glomerulonephritis can be restricted to the kidney or be secondary to a systemic disease 3, 4
- Glomerulopathies can be categorized into different types, including acute glomerulonephritis, rapidly progressive glomerulonephritis, nephrotic syndrome, and chronic glomerulonephritis 4