Glomérulopathies

Glomérulopathies are diseases that affect the glomeruli, the kidney’s microscopic filters. They can be primary, limited to the kidney, or secondary to systemic conditions such as autoimmune diseases, infections, or diabetes.

Clinical presentation ranges from asymptomatic abnormalities to nephritic or nephrotic syndromes. Nephritic features include hematuria, red cell casts, hypertension, and reduced kidney function. Nephrotic syndrome involves heavy proteinuria, hypoalbuminemia, edema, and sometimes high lipid levels.

Most glomerulopathies have immune-mediated causes, such as immune complex deposition, anti-glomerular basement membrane antibodies, or pauci-immune vasculitis; nonimmune mechanisms occur as well. Histology shows patterns such as mesangial or endocapillary proliferation, crescents, and varying sclerosis.

Common primary forms include minimal change disease, focal segmental glomerulosclerosis, membranous nephropathy, and IgA nephropathy; Alport syndrome is a hereditary basement membrane disorder. Secondary forms are linked to diabetes, lupus, infections, and vasculitis.

Diagnosis combines urinalysis, proteinuria quantification, kidney function tests, and serology for systemic disease. Renal biopsy with light microscopy, immunofluorescence, and electron microscopy provides definitive classification and informs treatment.

Management aims to treat the underlying condition, protect renal function, and reduce proteinuria. Practices include blood pressure control with renin-angiotensin blockers, avoidance of nephrotoxins, and selective immunosuppression for specific diseases. End-stage disease requires dialysis or transplantation.