Glomerulosclerosis

Glomerular Sclerosis, Segmental Hyalinosis, Chronic Membranous Glomerulonephritis

What is Glomerulosclerosis?

Glomerulosclerosis refers to transparent deposits or scarring that occurs as a result of damage within the kidney's glomeruli. Glomeruli are the tube-like structures within the kidney that filter impurities from the blood, and then excrete it as urine. Glomerulosclerosis may be the result of an underlying disease process including chronic liver disease (cirrhotic glomerulosclerosis), renal arteriosclerosis (hardening of the arteries in the kidneys), severe glomerulonephritis (inflammation of the glomeruli) with progressive kidney damage, and idiopathic nephrotic syndrome (focal glomerulosclerosis). Glomerulosclerosis can be associated with diabetes mellitus or reflux nephropathy (where urine flows from the bladder backwards into the kidney). High blood pressure (hypertension) or intravenous drug abuse may also cause glomerulosclerosis.

Mild glomerulosclerosis occurs normally with age. Renal function decreases ten percent each decade after age 30. Up to 75% reduction in renal function may still be compatible to normal life. Focal glomerulosclerosis (without a known cause) primarily affects males. Blacks have a higher risk of developing the disease.

How is it diagnosed?

History: Individuals may experience symptoms associated with liver disease, kidney disease, and diabetes mellitus, including increased or decreased urine output, severe edema (swelling of body parts due to fluid collection), or hematuria (blood in the urine).

Physical exam may reveal high blood pressure (hypertension).

Tests: Types of tests ordered may include asymptomatic proteinuria (to detect the presence of protein in the urine), hematuria (to detect the presence of blood in the urine), liver and kidney biopsy, light microscopy, and abnormal glomerular filtration rate.

How is Glomerulosclerosis treated?

Steroid therapy is often recommended. Other treatment may include cyclophosphamide. Experimental treatments with ACE inhibitors and cyclosporine are being studied. Liver transplant may be required for individuals with cirrhotic disease.

Medications

Information Brand Generic Label Rating
Atorvastatin Lipitor Atorvastatin Off-Label
Lasix Lasix Furosemide Off-Label
Motrin Motrin Ibuprofen Off-Label

Zocor (Simvastatin), Medrol (Methylprednisolone), Naprosyn (Naproxen)

What might complicate it?

Severe proteinuria (loss of protein from the blood into the urine) and nephrotic syndrome (a collection of symptoms and signs resulting from damaged glomeruli) are associated with higher relapse and mortality rates.

Predicted outcome

Prognosis for individuals who respond to steroid therapy is good. The ten-year survival rates are 25% to 55% for individuals with nephrotic syndrome, and 85% to 90% for individuals without. Most individuals with glomerulosclerosis experience end-stage renal failure within fifteen years.

Alternatives

A condition with similar symptoms is acute nephritic syndrome.

Appropriate specialists

Urologist, nephrologist, gastroenterologist, and transplant surgeon.

Last updated 20 May 2012


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