Glomerular diseases account for a significant proportion of acute and chronic kidney disease. Glomerular damage may follow a number of insults: immunological injury, inherited abnormality (e.g. Alport’s syndrome), metabolic stress (e.g. diabetes mellitus,), deposi-tion of extraneous materials (e.g. amyloid), or other direct injury to glomerular cells. The response of the glomerulus to injury and hence the predominant clinical features vary according to the nature of the insult. Glomerular diseases cause some or all of:
- leakage of cells and macromolecules across the glomerular filtration barrier proteinuria:characteristic of podocyte diseases or of alteration of architecture by scarring or deposition of foreign material haematuria:characteristic of inflammatory and destructive processes
- loss of filtration capacity (GFR)
Most patients with glomerular disease do not present acutely and are essentially asymptomatic, with abnormalities of blood or urine detected on routine screening, often accompanied by high blood pressure, with or without reduced GFR (glomerular filtration rate).