Membranous glomerulonephritis medical therapy: Difference between revisions
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==Overview== | ==Overview== | ||
Pharmacologic medical therapy is recommended among patients who has infectious, autoimmune causes of membranous glomerulonephritis. The preferred regimen is | Pharmacologic medical therapy is recommended among patients who has infectious, [[autoimmune]] causes of membranous glomerulonephritis. The preferred regimen is [[prednisone]] (0.5 mg/kg per day) with [[cyclophospamide]] IV for 3-5 months. Blood pressure can be controlled in patients with membranous glomerulonephritis usually requires more than [[angiotensin]] inhibition alone. | ||
==Medical Therapy== | ==Medical Therapy== | ||
Following is the treatment of membranous glomerulonephritis.<ref name="pmid29852477">{{cite journal| author=Bomback AS, Fervenza FC| title=Membranous Nephropathy: Approaches to Treatment. | journal=Am J Nephrol | year= 2018 | volume= 47 Suppl 1 | issue= | pages= 30-42 | pmid=29852477 | doi=10.1159/000481635 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=29852477 }}</ref><ref name="pmid22859855">{{cite journal| author=Waldman M, Austin HA| title=Treatment of idiopathic membranous nephropathy. | journal=J Am Soc Nephrol | year= 2012 | volume= 23 | issue= 10 | pages= 1617-30 | pmid=22859855 | doi=10.1681/ASN.2012010058 | pmc=3458460 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22859855 }}</ref><ref name="pmid10495797">{{cite journal |vauthors=Wasserstein AG |title=Membranous glomerulonephritis |journal=J. Am. Soc. Nephrol. |volume=8 |issue=4 |pages=664–74 |date=April 1997 |pmid=10495797 |doi= |url=}}</ref> | Following is the treatment of membranous glomerulonephritis.<ref name="pmid29852477">{{cite journal| author=Bomback AS, Fervenza FC| title=Membranous Nephropathy: Approaches to Treatment. | journal=Am J Nephrol | year= 2018 | volume= 47 Suppl 1 | issue= | pages= 30-42 | pmid=29852477 | doi=10.1159/000481635 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=29852477 }}</ref><ref name="pmid22859855">{{cite journal| author=Waldman M, Austin HA| title=Treatment of idiopathic membranous nephropathy. | journal=J Am Soc Nephrol | year= 2012 | volume= 23 | issue= 10 | pages= 1617-30 | pmid=22859855 | doi=10.1681/ASN.2012010058 | pmc=3458460 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22859855 }}</ref><ref name="pmid10495797">{{cite journal |vauthors=Wasserstein AG |title=Membranous glomerulonephritis |journal=J. Am. Soc. Nephrol. |volume=8 |issue=4 |pages=664–74 |date=April 1997 |pmid=10495797 |doi= |url=}}</ref> | ||
*Pharmacologic medical therapy is recommended among patients who has infectious, autoimmune causes of membranous glomerulonephritis. | *Pharmacologic medical therapy is recommended among patients who has infectious, autoimmune causes of membranous glomerulonephritis. | ||
*Pharmacologic medical therapies for membranous glomerulonephritis include (either) , antihypertensive therapy, anticoagulative therapy, antihyperlipid or immunosuppresion therapy. | *Pharmacologic medical therapies for membranous glomerulonephritis include (either) , [[antihypertensive]] therapy, [[anticoagulative]] therapy, [[antihyperlipid]] or [[immunosuppresion]] therapy. | ||
*Patients with autoimmune are treated with immunosuppressive therapy. | *Patients with [[autoimmune]] are treated with [[immunosuppressive]] therapy. | ||
*Patients with proteinuria are treated with antihypertensive and hyperlipidmic therapy. | *Patients with [[proteinuria]] are treated with antihypertensive and [[hyperlipidmic]] therapy. | ||
=== First-line immunosuppressive therapy: === | === First-line immunosuppressive therapy: === | ||
* The first line of immuneosuppressive therapy is given below:<ref name="pmid29852477" /><ref name="pmid22859855" /><ref name="pmid10495797" /> | * The first line of [[immuneosuppressive]] [[therapy]] is given below:<ref name="pmid29852477" /><ref name="pmid22859855" /><ref name="pmid10495797" /> | ||
* The preferred regimen is | * The preferred regimen is [[prednisone]] (0.5 mg/kg per day) with [[cyclophospamide]] IV for 3-5 months. | ||
* | * [[Methylprednisolone]] (0.4 mg/kg per day) given with [[cyclophosphamide]] (2.0 to 2.5 mg/kg per day) given IV for 2, 4, and 6 months. | ||
* Tacrolimus (0.05 mg/kg per day for) PO for 12 months with a six-month taper. | * [[Tacrolimus]] (0.05 mg/kg per day for) PO for 12 months with a six-month taper. | ||
* Rituximab (3.5g/day) IV for 6-12 months. | * [[Rituximab]] (3.5g/day) IV for 6-12 months. | ||
=== Treatment for proteinuria: === | === Treatment for proteinuria: === | ||
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==== Hpertensive managment: ==== | ==== Hpertensive managment: ==== | ||
* The goal blood pressure in patients with membranous glomerulonephritis is the same as it is in other patients with proteinuria chronic kidney disease. | * The goal blood pressure in patients with membranous glomerulonephritis is the same as it is in other patients with proteinuria [[chronic kidney disease]]. | ||
* [[angiotensin]] inhibitior (ACEi) for | * [[angiotensin]] inhibitior ([[ACEi]]) for | ||
* [[loop diuretics]] for | * [[loop diuretics]] for | ||
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===== Treatment for coagulation: ===== | ===== Treatment for coagulation: ===== | ||
* Low molecular weight or unfractionated heparin, followed by PO | * Low molecular weight or unfractionated [[heparin]], followed by PO [[warfarin]]. | ||
==References== | ==References== | ||
Revision as of 19:56, 23 July 2018
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Syed Ahsan Hussain, M.D.[2]
Overview
Pharmacologic medical therapy is recommended among patients who has infectious, autoimmune causes of membranous glomerulonephritis. The preferred regimen is prednisone (0.5 mg/kg per day) with cyclophospamide IV for 3-5 months. Blood pressure can be controlled in patients with membranous glomerulonephritis usually requires more than angiotensin inhibition alone.
Medical Therapy
Following is the treatment of membranous glomerulonephritis.[1][2][3]
- Pharmacologic medical therapy is recommended among patients who has infectious, autoimmune causes of membranous glomerulonephritis.
- Pharmacologic medical therapies for membranous glomerulonephritis include (either) , antihypertensive therapy, anticoagulative therapy, antihyperlipid or immunosuppresion therapy.
- Patients with autoimmune are treated with immunosuppressive therapy.
- Patients with proteinuria are treated with antihypertensive and hyperlipidmic therapy.
First-line immunosuppressive therapy:
- The first line of immuneosuppressive therapy is given below:[1][2][3]
- The preferred regimen is prednisone (0.5 mg/kg per day) with cyclophospamide IV for 3-5 months.
- Methylprednisolone (0.4 mg/kg per day) given with cyclophosphamide (2.0 to 2.5 mg/kg per day) given IV for 2, 4, and 6 months.
- Tacrolimus (0.05 mg/kg per day for) PO for 12 months with a six-month taper.
- Rituximab (3.5g/day) IV for 6-12 months.
Treatment for proteinuria:
Hpertensive managment:
- The goal blood pressure in patients with membranous glomerulonephritis is the same as it is in other patients with proteinuria chronic kidney disease.
- angiotensin inhibitior (ACEi) for
- loop diuretics for
Treatment for hyperlipidemia:
- Statins PO.
Treatment for coagulation:
References
- ↑ 1.0 1.1 1.2 Bomback AS, Fervenza FC (2018). "Membranous Nephropathy: Approaches to Treatment". Am J Nephrol. 47 Suppl 1: 30–42. doi:10.1159/000481635. PMID 29852477.
- ↑ 2.0 2.1 2.2 Waldman M, Austin HA (2012). "Treatment of idiopathic membranous nephropathy". J Am Soc Nephrol. 23 (10): 1617–30. doi:10.1681/ASN.2012010058. PMC 3458460. PMID 22859855.
- ↑ 3.0 3.1 3.2 Wasserstein AG (April 1997). "Membranous glomerulonephritis". J. Am. Soc. Nephrol. 8 (4): 664–74. PMID 10495797.