Encyclopedia of Health and Medicine

192 The Urinary System
Chronic glomerulonephritis may require long-term
medication therapy, and presents a significant risk
for progression to ESRD despite treatment.
Risk Factors and Preventive Measures
Diabetes and hypertension are the leading risk factors
for glomerulonephritis. Keeping these conditions
under control with medications and lifestyle
methods lowers the likelihood for damage to the
kidneys and can slow the progression of chronic
glomerulonephritis. Untreated or undertreated
(failing to complete the full course of antibiotics)
strep infections such as STREP THROAT or IMPETIGO
remain a significant source of bacterial infection
that causes glomerulonephritis. Though there are
no methods for preventing glomerulonephritis, the
doctor may recommend measures to slow its progression
such as dietary modifications (less sodium,
potassium, and protein; more water consumption).
See also GOODPASTURE’S SYNDROME; MEDICATIONS
TO TREAT CARDIOVASCULAR DISEASE; NEPHRITIS;
NEPHRON; NEPHROTIC SYNDROME; POLYARTERITIS; SYS-
TEMIC LUPUS ERYTHEMATOSUS (SLE).
glomerulosclerosis The formation of SCAR tissue
(fibrosis) within the glomeruli, the coiled capillary
networks within the nephrons of the KIDNEYS. The
most common presentation of glomerulosclerosis
is focal segmental glomerulosclerosis in which the
fibrosis is scattered throughout the glomeruli,
affecting only parts of the GLOMERULUS in various
nephrons. The damage permanently blocks the
affected glomeruli, however. Because the kidneys
have millions of nephrons, glomerulosclerosis may
be under way for a significant time before it
causes enough damage to manifest symptoms.
Some forms of glomerulosclerosis are familial
(have a hereditary component) and others arise in
conjunction with INFECTION such as HIV/AIDS. Most
often, however, the glomerulosclerosis is idiopathic—the
nephrologist can find no cause for the
scarring. Though some researchers believe the
cause is autoimmune, glomerulosclerosis does not
respond to IMMUNOSUPPRESSIVE THERAPY.
Symptoms and Diagnostic Path
Early symptoms of glomerulosclerosis are vague
and may not appear to be symptoms at all. They
include
• poor APPETITE in combination with weight gain
• edema (swelling) of the face, hands and wrists,
and feet and ankles
• foamy URINE, indicating ALBUMINURIA (excretion
of ALBUMIN, a form of protein, in the urine)
• discolored urine, indicating HEMATURIA (BLOOD in
the urine)
The diagnostic path begins with urinalysis,
which typically reveals the albuminuria as well as
hematuria. Needle biopsy of the kidney shows the
fibrosis among the glomeruli and may also show
the presence of Immunoglobulins characteristic of
the condition. HYPERTENSION (high BLOOD PRESSURE)
is also often present, a consequence of damage
that affects the parts of the NEPHRON that produce a
key HORMONE essential for blood pressure regulation
(RENIN). Because the kidneys also produce
ERYTHROPOIETIN (EPO), the hormone that stimulates
the BONE MARROW to produce erythrocytes (red
blood cells). Erythrocytes carry oxygen in the
blood circulation. Progressive glomerulosclerosis
often results also in ANEMIA (insufficient oxygen in
the blood circulation).
Treatment Options and Outlook
There is no cure for glomerulosclerosis, which in
most people progresses over about 10 years to
END-STAGE RENAL DISEASE (ESRD). Treatment includes
medications to control blood pressure. As CHOLES-
TEROL BLOOD LEVELS also tend to be high (HYPERLIPI-
DEMIA), the doctor may prescribe medications and
lifestyle changes to help bring them down. These
therapies may slow the progression of the fibrosis.
The progressive loss of protein further damages
the nephrons. At the point of ESRD, long-term
RENAL DIALYSIS or KIDNEY TRANSPLANTATION is necessary
to sustain life.
Risk Factors and Preventive Measures
Glomerulosclerosis, particularly focal segmental,
tends to develop in people who are in their 20s and
30s and is about three times more common among
African American males. There are no measures to
prevent glomerulosclerosis. Managing the symptoms
as effectively as possible may delay the onset
of ESRD. Kidney transplantation becomes the
treatment option that offers the greatest opportunity
for a return to normal activities.