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What Is Glomerulosclerosis?

Glomerulosclerosis is a health condition that causes sclerosis scarring or hardening of tiny blood vessels in the kidneys called glomeruli. Within the glomeruli, waste and fluid is filtered from the blood and removed from the body through urine.

Both children and adults can be diagnosed with glomerulosclerosis, and almost 20% of adults with kidney disease will develop it.

What causes glomerulosclerosis?

There are several causes of glomerulosclerosis, including diabetes and lupus. In the United States, diabetes is the leading cause of kidney disease. High blood glucose (sugar) levels can lead to damage and scarring of the kidneys. Diabetes can also increase the pressure within the glomeruli, which over time can cause injury and scarring, as does high blood pressure.

Another kidney disease that can lead to glomerulosclerosis is called focal segmental glomerulosclerosis (FSGS). Focal means that only some of the glomeruli become scarred; the rest are unchanged. The word segmental means that only a portion of a glomerulus is scarred. FSGS can result from many causes, including infections, pain medications or illicit drug use, obesity and cancer; however, the cause is unknown in a majority of FSGS cases.

What are the symptoms of glomerulosclerosis?

In the early stages of glomerulosclerosis, a person may not show any symptoms at all, similar to early stage kidney disease. When someone has glomerulosclerosis, the scarring can alter the filtering process in the kidneys, allowing protein to move from the blood into the urine, which is called proteinuria. Proteinuria is when large amounts of protein are lost in the urine, and is identified through a lab test called a urinalysis. Signs of large protein loss proteinuria include:

swollen ankles and hands;
eye puffiness;
abdominal fluid retention;
foamy urine.

Can glomerulosclerosis be treated?

If caught early enough, all kidney disease can be managed. The greater the delay in seeing a kidney specialist the less chance a patient can preserve their kidney function. When a person is diagnosed with glomerulosclerosis, kidney function worsens because of progressive scarring of the glomeruli. People may gradually lose kidney function until their kidneys fail. The time it takes a patient with glomerulosclerosis to go from diagnosis to end stage renal disease ranges from 1-10 years — sometimes even longer. Kidney failure is also known as end stage renal disease (ESRD), or stage 5 kidney disease. When someone’s kidneys fail, they will need dialysis, and can also be on a list to receive a kidney transplant.

To determine treatment options for glomerulosclerosis, a patient’s health care team must first determine what caused the damage to the glomeruli. To do this, a kidney biopsy is performed by inserting a needle into the kidney and removing small bits of tissue. The tissue is then examined.

For about half of all people with glomerulosclerosis, a doctor can prescribe immunosuppressants to stop proteinuria, the same drugs that help prevent the rejection of transplanted organs. But if a person stops the medication, the proteinuria can come back.

Many times doctors will order a treatment plan that includes adequate nutrition, diuretics, and a prescription blood pressure medicine called an angiotensin-converting enzyme (ACE) inhibitor. ACE inhibitors lower blood pressure, in turn helping slow the progression of kidney disease. Sometimes a low-protein diet is recommended so that the kidneys do not have to work as hard to remove protein waste from the body. Those with kidney disease may also need to control their cholesterol by taking medication, eating a low-cholesterol diet or both. Immunosuppressive therapy a treatment that stops the body from attacking its own tissues with a steroid such as prednisone can also be prescribed to stop proteinuria. Studies have shown that 30-60% of patients benefit from this therapy.

Summary

Glomerulosclerosis can be difficult to detect in its early stages, much like other kidney diseases. If a person has diabetes, lupus, infections or another disease that could harm the kidneys, a doctor should test for glomerulosclerosis. If a diagnosis is made, the doctor can prescribe medicines to control this condition as well as dietary changes for overall kidney health.