What is it?
Renal functional units are nephrons (approximately 1 million nephrons per kidney). Each nephron is composed of a glomerulus and tubule. The renal glomerulus functions as a kind of filter that retains proteins and blood cells and passes water, catabolic substances, and salts from the renal tubule. This process is called glomerular filtration. Renal tubule modifies filtrate into urine. Glomerular diseases (glomerulonephritis) are diseases that affect the renal glomeruli, compromising their filtering capacity, letting out blood components normally retained: proteins and red blood cells. This loss deprives the blood of the components important for the balance of body fluids, with possible occurrence of edema, anemia and hypertension. Possible causes of glomerular disease include: genetic (Alport syndrome), metabolic (diabetes), storage (amyloidosis), immune (glomerulonephritis) or infectious (HIV, malaria) diseases.
Which are the symptoms?
Glomerulonephritis are the diseases that originate in the renal glomerulus. The main manifestations of glomerulonephritis are: hematuria, proteinuria, impaired renal function (elevated creatinineemia), arterial hypertension, edema. It is important to distinguish two clinical forms of presentation: 1) nephritic syndrome: characterized by proteinuria, red blood cells in the urine up to macrohematuria, arterial hypertension and edema. This syndrome is caused by damage of an inflammatory nature to the glomerulus. 2) Nephrotic syndrome: characterized by proteinuria (greater than 3.5 grams in 24 hours) usually without hematuria, hypoalbuminemia and edema.
How is it diagnosed?
At the presence of clinical manifestations of glomerulonephritis, a diagnostic pathway is started with haematochemical examinations aimed at assessing renal function (urine test, ultrasound, creatinine dosage, 24-hour proteinuria). The purpose of the urine test is both to search for and quantify the presence of proteinuria and/or hematuria, and to be able to perform a urinary sediment that is very useful in diagnostic guidance. An immunological screening can then be performed to look for specific antibodies. In many cases, the diagnostic pathway for these diseases may finish in renal biopsy, which allows identification of the type of glomerular disease in progress, which would not otherwise be recognizable. Biopsy diagnosis allows starting targeted therapy.
How is it treated?
The treatment of glomerulonephritis is complex and varies depending on many factors such as the patient's clinical status, renal damage, renal histological changes found after biopsy, etc. One of the first goals is the control of arterial hypertension with drug therapy; in addition, drugs are used to reduce the progression of kidney damage and loss of protein with urine. In more severe cases, immunosuppressive therapy with corticosteroids or other immunosuppressants will be required to reduce glomerular inflammation.
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