Glomerulation

Glomerulation refers to bladder hemorrhages which are thought to be associated with some types of interstitial cystitis (IC).

The presence of glomerulations, also known as petechial hemorrhages, in the bladder suggests that the bladder wall has been damaged, irritated and/or inflamed. In fact, the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) Diagnostic Criteria for IC, developed in 1987, required the presence of glomerulations or Hunner's Ulcers for diagnosis of IC and is still used, today, to determine patient eligibility for some clinical trials.[1] Research conducted by Waxman, however, determined that the hydrodistention procedure itself may have created these tiny broken blood vessels. Thus, a diagnosis of IC is now based upon other, less invasive methods, such as the PUF questionnaire.

Presentation

Glomerulations can be found in the 3 quadrants of the bladder, appearing as checkerboard/lattice patterns, splotches, or pinpoint-sized red marks on the bladder.[2][3]

Relation to Interstitial Cystitis

The identification of glomerulations as diagnostic criteria for interstitial cystitis/ bladder pain syndrome is unclear. [4] In 1987, the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) developed diagnostic criteria for IC which included the presence of glomerulations or petechial hemorrhages.[1] The purpose of the NIDDK diagnostic criteria was to facilitate comparable patient groups for research.[5] It was not intended to set strict criteria for the diagnosis of IC.

Treatment

In addition to traditional IC therapies, diet modification remains a core self care strategy as foods that are irritating to the bladder dramatically worsen the symptoms that patients may experience. Foods high in acid and/or caffeine (such as all coffees, regular teas, green teas, sodas, diet sodas, artificial sweeteners and most fruit juices) should be avoided. The daily goal of patients should be to soothe rather than irritate the bladder wall.

References
  1. Gillenwater Jay Y.; Wein Alan J. (1988). "Summary of the National Institute of Arthritis, Diabetes, Digestive and Kidney Diseases Workshop on Interstitial Cystitis, National Institutes of Health, Bethesda, Maryland, August 28-29, 1987". Journal of Urology. 140 (1): 203–206. doi:10.1016/S0022-5347(17)41529-1.
  2. "How is a finding of glomerulations characterized in interstitial cystitis/bladder pain syndrome (IC/BPS)?". www.medscape.com. 2018. Retrieved 2020-07-28.
  3. "Cystoscopy with Hydrodistention". Interstitial Cystitis Association. 2015. Retrieved 2020-07-28.
  4. Wennevik Gjertrud E.; Meijlink Jane M.; Hanno Philip; Nordling Jørgen (2016). "The Role of Glomerulations in Bladder Pain Syndrome: A Review". Journal of Urology. 195 (1): 19–25. doi:10.1016/j.juro.2015.06.112.
  5. Hanno, Philip M (2002). "Interstitial Cystitis—Epidemiology, Diagnostic Criteria, Clinical Markers". Reviews in Urology. 4 (Suppl 1): S3–S8. ISSN 1523-6161. PMC 1476008. PMID 16986032.
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