Glomerular Diseases: What Is It, Causes, Symptoms, Treatment

Glomerular diseases are disorders that affect the glomeruli (microscopic filtering units within the kidneys). Each kidney contains around one million glomeruli, which are clusters of tiny blood vessels responsible for filtering waste, excess fluids, & electrolytes from the blood to form urine.

The glomeruli are part of the nephron, the functional unit of the kidney, and are lined with a specialized basement membrane, endothelial cells, and podocytes that together maintain filtration selectivity. When this structure is damaged, protein and blood can leak into the urine, and the kidneys' ability to filter waste is compromised.

Glomerular disease is not one condition but a group of disorders that can be caused by infections, autoimmune responses, genetic mutations, or systemic diseases such as diabetes or lupus. These conditions may occur suddenly (acute) or progress slowly over time (chronic), often leading to impaired kidney function or kidney failure if left untreated.

Function of Glomeruli 

A glomerulus is a compact tangle of capillaries housed within a structure called Bowman’s capsule. As blood flows into these capillaries, it is filtered through a three-layer barrier: the inner lining of endothelial cells (which contain pores), a shared glomerular basement membrane (which acts as a size and charge filter), and a final layer of podocytes (specialized epithelial cells with foot-like projections that further restrict passage). This barrier is designed to let water and small molecules pass through while retaining larger proteins and blood cells in the bloodstream.

Filtration is driven by pressure. Specifically, hydrostatic pressure from incoming arterial blood pushes plasma through the filtration barrier. The filtered fluid, called filtrate, then enters the tubules of the nephron, where electrolytes and other substances are adjusted before forming urine.

When glomerular disease sets in, one or more components of this filtration system break down. Damage to the basement membrane or loss of podocyte integrity can make the barrier too “leaky,” allowing proteins (proteinuria) or red blood cells (hematuria) to pass into the urine. 

In inflammatory conditions, white blood cells may infiltrate and disrupt the glomerular structure. Over time, persistent injury can lead to scarring (glomerulosclerosis), thickening of the basement membrane, or collapse of capillary loops, all of which reduce filtration surface area and lower the glomerular filtration rate (GFR).

The net result: the kidney becomes less efficient at clearing waste and maintaining fluid, electrolyte, and acid-base balance. Left unchecked, this dysfunction can progress to chronic kidney disease and ultimately kidney failure.

Symptoms of Glomerular Disease

• Swelling in the face, hands, feet, or abdomen (edema)
• Foamy urine (due to proteinuria)
• Blood in the urine (hematuria)
• High blood pressure (hypertension)
• Decreased urine output
• Fatigue
• Nausea or loss of appetite
• Weight gain (from fluid retention)
• Shortness of breath (from fluid overload)
• Muscle cramps or weakness (in advanced stages)

Causes of Glomerular Disease

• Vasculitis—blood-vessel inflammation
• Polyarteritis affecting small/medium vessels in kidneys and organs
• Granulomatosis with polyangiitis (formerly Wegener’s)
• Scarring conditions (glomerulosclerosis)
• Long-standing, uncontrolled high blood pressure
• Diabetes-induced nephropathy
• Focal segmental glomerulosclerosis (FSGS): patchy scarring, idiopathic or secondary to other conditions
• Infections and immune reactions
• Post-streptococcal infections
• Chronic viral infections (e.g., HIV, hepatitis B/C)
• Autoimmune triggers (e.g., systemic lupus)
• Genetic and familial forms
• Alport syndrome (inherited, often with hearing or vision issues)
• Familial glomerulonephritis variants of unknown etiology
• Cancer-related associations
• Gastric cancer
• Lung cancer
• Chronic lymphocytic leukemia

Tests and Diagnostic Procedures 

• Urinalysis: Detects proteinuria, hematuria, and presence of cellular casts. A basic but essential indicator of glomerular damage.
• Urine Protein-to-Creatinine Ratio (UPCR) or 24-Hour Urine Collection: Quantifies the amount of protein being lost in urine. Helps assess severity and monitor progression.
• Blood Tests: Measures levels of creatinine & blood urea nitrogen (BUN) to estimate kidney function. A low estimated glomerular filtration rate (eGFR) indicates impaired filtration.
• Serologic Tests: Screens for underlying autoimmune or infectious causes (e.g., ANA for lupus, anti-GBM antibodies, ANCA, hepatitis B/C markers, HIV, streptococcal antibodies).
• Complement Levels (C3, C4): Reduced complement levels can suggest certain immune-mediated glomerular diseases, like lupus nephritis or post-infectious glomerulonephritis.
• Imaging: Renal Ultrasound: Assesses kidney size, structure, and rules out obstruction or cystic disease. Also helps identify chronic scarring.
• Kidney Biopsy: The definitive diagnostic tool. Involves extracting a tiny tissue sample for microscopic examination. Identifies specific patterns of injury (e.g., focal segmental glomerulosclerosis, membranous nephropathy) and guides targeted treatment.

Treatment Options for Glomerular Disease

• Immunosuppressive Therapy: Corticosteroids and other agents such as cyclophosphamide, mycophenolate mofetil, or calcineurin inhibitors are used to suppress immune activity in cases with autoimmune or inflammatory origin.
• Plasma Exchange (Plasmapheresis): In certain aggressive forms (e.g., anti-GBM disease, ANCA-associated vasculitis), plasma exchange is used to remove harmful antibodies from the bloodstream.
• Antibiotic or Antiviral Therapy: When glomerular disease is triggered by infections (e.g., post-streptococcal, hepatitis B or C), targeted antimicrobial treatment is essential to eliminate the underlying cause.
• Biologic Agents: In selected cases, biologics such as rituximab may be used, particularly for diseases like membranous nephropathy or lupus nephritis, where B-cell suppression is indicated.
• Kidney Transplantation: In end-stage cases where kidney function is irreversibly lost, transplantation becomes the definitive treatment option. May be considered after disease control or remission, depending on recurrence risk.

Management of Glomerular Disease

• Blood Pressure Control: Use of ACE inhibitors or ARBs to maintain target blood pressure and reduce proteinuria. Tight control slows the progression of kidney damage.
• Dietary Modifications: Restriction of sodium, protein, and fluid intake to manage edema and reduce kidney workload. Tailored by disease severity and lab values.
• Blood Sugar Control (for diabetic patients): Intensive glycemic control helps prevent worsening of glomerular injury in diabetic nephropathy.
• Cholesterol Management: Statins may be prescribed to manage dyslipidemia, which is common in nephrotic syndrome and increases cardiovascular risk.
• Monitoring Kidney Function: Regular testing of creatinine, eGFR, and protein levels in urine to assess response to treatment and disease progression.
• Managing Anemia and Bone-Mineral Disorders: Use of erythropoiesis-stimulating agents and phosphate binders as needed in chronic kidney disease stages.
• Vaccinations: Recommended immunizations (e.g., pneumococcal, influenza, hepatitis B) to reduce infection risk, especially in immunosuppressed patients.

Outlook and Prognosis for Glomerular Disease

The long-term outcome depends on various factors like underlying cause, speed of diagnosis, and response to treatment. Some forms, exceptionally mild post-infectious types, may resolve completely with supportive care. Others, particularly autoimmune or progressive scarring diseases like focal segmental glomerulosclerosis, often lead to chronic kidney damage.

When diagnosed early and managed aggressively, many patients can stabilize kidney function and avoid dialysis. However, delayed or inadequate treatment increases the risk of irreversible damage, reduced glomerular filtration rate (GFR), and eventual kidney failure.

Patients with chronic or relapsing forms require lifelong monitoring and may progress to end-stage kidney disease requiring dialysis or transplantation. Regular follow-up & adherence to treatment are critical for preserving function and extending survival.

Sterling Hospital is Your Partner in Better Health Across Gujarat

At Sterling Hospital, we provide you with the utmost care and comfort throughout your journey to healthy kidneys. If you are looking for the best kidney specialist in Ahmedabad - Gurukul, Vadodara - Race Course Road, Vadodara - Bhayli, and Gandhidham we've got you. 

With considerable years of experience, we have built a team of the best nephrologists in these regions to provide you with premium treatment and the best results. Safeguard your kidney health and contact Sterling Hospital to schedule a consultation and embark on a journey towards a healthier life.