Glomerulopathy

Glomerulopathy is a broad term for diseases that primarily affect the glomeruli, the microscopic filtration units of the kidney. It includes both primary glomerular diseases, arising in the kidney, and secondary glomerular diseases caused by systemic conditions such as diabetes, lupus, infections, or vasculitis.

Clinical presentation ranges from isolated proteinuria to full nephrotic or nephritic syndromes. Common findings include edema, hypertension, reduced kidney function, hematuria, and varying degrees of proteinuria.

Pathophysiology involves injury to the glomerular filtration barrier, including endothelial cells, the basement membrane, and podocytes, leading to leakage of protein and, in some diseases, inflammation and scarring.

Classification emphasizes primary glomerulopathies (for example, minimal change disease, focal segmental glomerulosclerosis, membranous nephropathy, and IgA nephropathy) and secondary glomerulopathies (for example, diabetic nephropathy, lupus nephritis, vasculitis, and amyloidosis). Histology from renal biopsy often guides management.

Diagnosis relies on urinalysis with protein and blood testing, quantification of proteinuria, assessment of renal function, blood pressure monitoring, and serologic tests for systemic diseases. Renal biopsy with light microscopy, immunofluorescence, and electron microscopy is used to define histology when needed.

Management targets include protecting renal function and reducing proteinuria, often with blood pressure control using ACE inhibitors or ARBs, edema management, and lifestyle measures. Disease-specific therapies may include immunosuppressants for certain glomerulonephritides. In end-stage disease, dialysis or transplantation may be required.

Prognosis varies by underlying disease and response to treatment; some glomerulopathies resolve or stabilize, while others progress to chronic kidney disease. Regular monitoring is essential.