Membranoproliferative glomerulonephritis medical therapy: Difference between revisions
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{{Membranoproliferative glomerulonephritis}} | {{Membranoproliferative glomerulonephritis}} | ||
{{CMG}} {{APM}} {{AE}} {{OO}} | {{CMG}} {{APM}} {{AE}} {{OO}} {{JSS}} | ||
== Overview == | == Overview == | ||
The treatment of membranoproliferative glomerulonephritis depends on the cause of the disease.In infectious and haematological etiology treating the underlying infection will result in resolution of membranoproliferative glomerulonephritis.For autoimmune etiology immunosuppressive agents are given.The treatment also includes [[antihypertensive]] therapy, anticoagulation therapy and anti-lipid therapy for nephrotic syndrome. | The treatment of membranoproliferative glomerulonephritis depends on the cause of the disease.In [[Infection|infectious]] and haematological etiology treating the underlying infection will result in resolution of membranoproliferative glomerulonephritis.For [[Autoimmunity|autoimmune]] etiology [[Immunosuppression|immunosuppressive]] agents are given.The treatment also includes [[antihypertensive]] therapy, [[Anticoagulant|anticoagulation therapy]] and [[Statins|anti-lipid]] therapy for [[Nephrotic syndrome|nephrotic syndrome.]] | ||
== Medical Therapy == | == Medical Therapy == | ||
* Pharmacologic therapy is recommended for patients of membranoproliferative glomerulonephritis. | * Pharmacologic therapy is recommended for patients of membranoproliferative 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><ref name="pmid15847250">{{cite journal |vauthors=Ozsoy RC, Koopman MG, Kastelein JJ, Arisz L |title=The acute effect of atorvastatin on proteinuria in patients with chronic glomerulonephritis |journal=Clin. Nephrol. |volume=63 |issue=4 |pages=245–9 |date=April 2005 |pmid=15847250 |doi= |url=}}</ref> | ||
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* The treatment depends on the cause of the disease. | * The treatment depends on the cause of the disease. | ||
* Patients with [[Autoimmune|autoimmuneetiology]] are treated with [[immunosuppressive]] therapy | * Patients with [[Autoimmune|autoimmuneetiology]] are treated with [[immunosuppressive]] therapy | ||
* Patients with infectious etiology are treated with antivirals or antibiotics depending on the cause. | * Patients with infectious etiology are treated with antivirals or [[Antibiotic|antibiotics]] depending on the cause. | ||
* Hepatitis B and Hepatitis C are treated with antivirals. | * [[Hepatitis B]] and [[Hepatitis C]] are treated with antivirals. | ||
* Leukemias and lymphomas treated with chemotherapy. | * [[Leukemia|Leukemias]] and [[Lymphoma|lymphomas]] treated with [[chemotherapy]]. | ||
* Other pharmacologic medical therapies for membranoproliferative glomerulonephritis include [[antihypertensive]] therapy, anticoagulation therapy and anti-lipid therapy. | * Other pharmacologic medical therapies for membranoproliferative glomerulonephritis include [[antihypertensive]] therapy, anticoagulation therapy and anti-lipid therapy. | ||
'''1. Patients with autoimmune etiology''' | '''1. Patients with autoimmune etiology''' | ||
Revision as of 17:35, 30 July 2018
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Ali Poyan Mehr, M.D. [2] Associate Editor(s)-in-Chief: Olufunmilola Olubukola M.D.[3] Jogeet Singh Sekhon, M.D. [4]
Overview
The treatment of membranoproliferative glomerulonephritis depends on the cause of the disease.In infectious and haematological etiology treating the underlying infection will result in resolution of membranoproliferative glomerulonephritis.For autoimmune etiology immunosuppressive agents are given.The treatment also includes antihypertensive therapy, anticoagulation therapy and anti-lipid therapy for nephrotic syndrome.
Medical Therapy
- Pharmacologic therapy is recommended for patients of membranoproliferative glomerulonephritis.[1]>[2][3][4]
.
- The treatment depends on the cause of the disease.
- Patients with autoimmuneetiology are treated with immunosuppressive therapy
- Patients with infectious etiology are treated with antivirals or antibiotics depending on the cause.
- Hepatitis B and Hepatitis C are treated with antivirals.
- Leukemias and lymphomas treated with chemotherapy.
- Other pharmacologic medical therapies for membranoproliferative glomerulonephritis include antihypertensive therapy, anticoagulation therapy and anti-lipid therapy.
1. Patients with autoimmune etiology
1.1 Immunosuppressive therapy:
- Preferred regimen (1): Prednisone 0.5 mg/kg per day with cyclophosphamide IV for 3-5 months
- Preferred regimen (2): 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
- Preferred regimen (3): Tacrolimus 0.05 mg/kg per day for PO for 12 months with a six-month taper
- Preferred regimen (4): Rituximab 3.5g/day IV for 6-12 months
2. Treatment for nephrotic sydnrome:
2.1 Antihypertensive therapy
- Preferred regimen (1) Losartan PO for 50 mg q daily (100mg per day)
2.2 Anticoalgulation tharapy
- Low molecular weight or unfractionated heparin, followed by PO warfarin.
2.3 Anti-lipid therapy
2.3.1 Life-style modification
- Decrease salt intake
- Weight loss
2.3.2 Statins
- Atorvastatin PO 10mg q daily
References
- ↑ Bomback AS, Fervenza FC (2018). "Membranous Nephropathy: Approaches to Treatment". Am J Nephrol. 47 Suppl 1: 30–42. doi:10.1159/000481635. PMID 29852477.
- ↑ 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.
- ↑ Wasserstein AG (April 1997). "Membranous glomerulonephritis". J. Am. Soc. Nephrol. 8 (4): 664–74. PMID 10495797.
- ↑ Ozsoy RC, Koopman MG, Kastelein JJ, Arisz L (April 2005). "The acute effect of atorvastatin on proteinuria in patients with chronic glomerulonephritis". Clin. Nephrol. 63 (4): 245–9. PMID 15847250.