Glomerular diseases affect the glomeruli — the tiny blood vessels that filter blood in your kidneys. When glomeruli are damaged, it disrupts the balance of protein, waste, acids, and other substances in your blood. This can lead to nephrotic syndrome, acute kidney failure (sudden loss of kidney functioning), or chronic kidney failure.

There are two types of glomerular diseases:

• Glomerulonephritis: swelling of the glomeruli tissue
• Glomerulosclerosis: hardening in the blood vessels that causes kidney scarring

In children and adults, these diseases can be caused by kidney disease alone (primary) or result from infections, autoimmune disorders, vasculitis (swelling of blood vessels), and hereditary diseases such as:

• Diabetic nephropathy: chronic kidney disease related to increased blood glucose
• Focal segmental glomerulosclerosis: scarring in different parts of the kidney caused by a systemic condition (affects many areas of your body) or progressive kidney disease
• Hereditary nephritis (Alport syndrome): Chronic kidney disease, along with hearing, vision, and skin problems
• HIV-associated nephropathy: fast-developing kidney damage that can lead to chronic kidney failure
• Immunoglobulin A (IgA) nephropathy: silent, progressive kidney disease caused by IgA protein buildup in the glomeruli
• Membranous nephropathy: kidney damage caused by glomeruli thickening
• Minimal change disease: involves nephrotic syndrome without kidney scarring (occurs mainly in childhood)
• Polyarteritis: a form of vasculitis that affects small and medium blood vessels, including vessels in the heart, kidneys, and intestines
• Post-infectious glomerulonephritis: kidney damage that happens after bacterial infection, such as strep throat or impetigo, due to a stimulated immune system (mainly occurs in children)
• Renal limited vasculitis or ANCA glomerulonephritis: damage to the capillaries, resulting in swelling and loss of kidney function
• Systemic lupus erythematosus: an autoimmune disease that can affect kidney function (lupus nephritis)

The signs, symptoms, and complications of glomerular diseases in children and adults vary. Glomerular diseases can cause:

• Proteinuria: a life-threatening protein buildup in the urine
• Hematuria: blood in the urine
• Edema: swelling
• High blood pressure (hypertension)
• Damage to the heart, lungs, liver, and intestines

The nephrologists (kidney specialists) at University of Miami Health System will treat the underlying causes of acute and chronic glomerular diseases and preserve as much kidney function as possible.

Tests

Biopsy
A kidney biopsy is a tissue sample taken from the kidney through a needle and analyzed at a lab. Results help your doctor diagnose the type of kidney disease, assess kidney damage, and determine the best treatment.

Blood Tests
Doctors use blood tests to help diagnose kidney problems and evaluate your kidney function, including blood cell counts and electrolyte levels. During a kidney function test, the glomerular filtration rate (GFR) measures the protein, albumin, and creatinine levels in the blood.

Imaging Exams
Diagnostic imaging shows kidney size and function, as well as obstructions or structural problems in your kidney or urinary tract. Doctors use ultrasound, X-ray, CT (computed tomography), and magnetic resonance imaging (MRI).

Intravenous Pyelogram (IVP)
An IVP is an X-ray that shows the kidneys, bladder, and urinary tract (ureters and urethra). It can show the size, shape, and position of your urinary tract, and help your doctor evaluate kidney function.

Urinalysis
Doctors use urine samples to look for red blood cells, white blood cells, infections, or excessive protein in your urine. Your doctor may take a sample during your appointment, arrange urine collection over 24 hours, or take a sample directly from your bladder using a catheter (thin, flexible tube).

Treatments

Dialysis
Dialysis mechanically performs the function of your kidneys. It’s not a cure for kidney disease, but it can make you feel better and live longer. There are different types of dialysis, which can take place at one of our facilities or at home. Types of dialysis include:

• Hemodialysis: This form of dialysis uses a machine, called a dialyzer, to clean your blood outside of your body. Your doctor will do a minor surgery (called dialysis access) to prepare a vein in your arm for removing and returning blood. During dialysis, blood is taken out of the access point with a needle, passed through the dialyzer, and returned to your body through a different needle. Hemodialysis treatments take a few hours and are performed a few times a week.

• Peritoneal Dialysis: This form of dialysis uses your own body to filter blood using a catheter (a thin, flexible tube) placed in your navel. In a process called an exchange, a solution is passed through the catheter into your abdomen either by hand or a machine. The solution soaks up waste and excess body fluids and returns it to a collection bag. The procedure is usually performed four or more times a day, and each exchange takes a few hours.

Continuous Renal Replacement Therapy (CRRT)
This therapy includes hemodialysis and other mechanical waste filtration techniques performed slowly over long periods of time (12 to 24 hours). CRRT is used for critically ill people with sudden (acute) kidney failure.

Total Plasma Exchange (TPE)
Total plasma exchange, also called plasmapheresis, is a blood-cleaning therapy that removes your blood through a needle or catheter (thin, flexible tube). The plasma is separated, cleaned, and returned to your body. Doctors use TPE to treat some autoimmune disorders and remove excess proteins from your blood. It’s used in combination with other treatment therapies for glomerular diseases.

Dietary Changes
We recommend a low-salt diet to reduce swelling. Your doctor may also ask you to restrict your protein intake to help slow the progression of kidney disease. Our dietitians can educate you about a healthy diet and how to incorporate your doctor’s guidelines into your lifestyle.

Hormone Therapy
Kidney disease can be associated with hyper or hypothyroidism, which impacts weight, heart rate, and body temperature, and may cause fatigue. Your doctor may recommend thyroid hormone therapy to restore a healthy balance. Doctors also use adrenocorticotropic hormone (ACTH) to treat nephrotic syndrome. ACTH releases cortisol, which helps regulate your metabolism and blood pressure.

Kidney Transplant
If dialysis or other therapies no longer work, your doctor may recommend a kidney transplant.

Why Choose UHealth?

Nationally recognized kidney care. Our kidney care program has been ranked among the nation’s best programs by U.S. News & World Report for the past nine years. We use preventive approaches to help avoid kidney injury and disease, along with advanced therapies to improve kidney health and function. We offer some of the most advanced kidney therapies, including continuous renal replacement therapy (CRRT) and therapeutic plasma exchange (TPE).

Comprehensive care in a compassionate, supportive environment. Kidney health impacts vital functions throughout your body. The kidneys can also be impacted by autoimmune or genetic disorders, which can lead to additional complications. That’s why our nephrologists work as part of a team to address the whole person. This group can include general physicians and specialists, nurses, social workers, dietitians, psychologists, and teachers.

World-class care in an academic health system. We’re recognized by the National Institutes of Diabetes and Digestive and Kidney Diseases as a Center of Excellence and a leader in treating kidney conditions. Backed by one of the nation’s top universities, our team uses the latest technologies and research-driven expertise to provide you with superior, personalized care and the latest treatment options.

Highest patient survival rate after transplant. The Kidney Transplant Program at the University of Miami Miller School of Medicine/Jackson Memorial Medical Center have performed more than 250 kidney and combined kidney-pancreas transplants. This expertise earned us recognition by the U.S. Department of Health and Human Services for the largest volume in the nation and the highest transplant success and patient survival after kidney transplant. In addition, our Kidney Paired Donor Exchange Program gives those who need a kidney transplant a better chance of finding a match. With this program, donors that aren’t a medical match for the patient can take part in an exchange program that matches them with another recipient/donor.