Focal segmental glomerulosclerosis is a pathological lesion that affects the glomeruli. This sclerosis is associated with proteinuria, which if continued for a long time leads to damage to the kidneys and impairment of their basic function, i.e. filtration. The cause of the disease is still unclear, but it is assumed that these are primarily disorders of the immune system.
Focal segmental glomerulosclerosismainly affects young men. The name of the disease is associated with the morphological picture. The microscopic examination shows fibrosis and glazing of the glomeruli, as well as some fragments of entire vascular loops. All this impairs filtration, so it significantly reduces the removal of accumulated toxins from the body.
Glomerular sclerosis: symptoms
The symptoms of the disease appear gradually, and their severity depends strictly on the degree of the involved glomeruli. Many of the symptoms are not necessarily attributed to this disease entity alone, but may accompany others, which are difficult to diagnose. The most significant are:
- nephrotic syndrome, which is a symptom complex caused by the excessive loss of protein in the urine (more than 3.5 grams / day); in addition, there is lipiduria, hyperlipemia and edema
- hematuria, i.e. the presence of red blood cells in the urine
- in the case of long-lasting symptoms, hypertension develops, which further weakens the functioning of the kidneys
- swelling, not only peripheral, but also around the eyelids
- in the general urine examination, the key is to identify non-selective proteinuria, which means that various proteins, not only albumin, appear in the urine; after some time, other compounds are observed, such as amino acids, glucose or phosphates - all this indicates damage to the renal tubules
Diagnosis of glomerulosclerosis
Diagnosis of the disease requires the implementation of appropriate diagnostics. It is extremely important to take a detailed interview with the patient and identify the main complaints. First, the doctor orders a general urine test, which shows non-selective proteinuria, sometimes hematuria. As the disease progresses, it is observeda tendency to higher blood pressure values.
A kidney biopsy with a histopathological evaluation is necessary for the final diagnosis. Since the symptomatology is unclear, different disease states that can lead to similar morphological changes in the glomeruli should be considered in differentiation. You should take into account: secondary forms of glomerulosclerosis, for example in the course of severe obesity or in drug addicts who regularly use heroin.
Treatment of glomerulosclerosis
The therapeutic management of glomerulosclerosis depends strictly on the progression of the diagnosed disease. It takes into account not only the clinical condition of the patient, but also the severity of the proteinuria. A low degree of proteinuria can be controlled by modifying the diet - limiting the supply of protein and s alt. Sometimes pharmacotherapy is required - convertase inhibitors are the first-line drug. Patients with severe proteinuria are subject to more advanced therapeutic management, namely glucocorticoid therapy (receiving steroids), sometimes in combination with immunosuppressive therapy.
The prognosis is serious, almost half of the patients develop end-stage renal disease after 10 years. The course of the disease varies and, as mentioned above, it depends, among others, on on the severity of proteinuria.
Unfortunately, each pharmacological action carries a risk of side effects, especially in patients undergoing steroid therapy. Very often there are infections, stomach ulcers, diabetes or other distribution of adipose tissue, which is commonly referred to as the buffalo neck. All this results in a reduction of the therapeutic dose, which unfortunately delays the effectiveness of the treatment of glomerulopathy.