Membranoproliferative glomerulonephritis medical therapy: Difference between revisions
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__NOTOC__ | __NOTOC__ | ||
{{Membranoproliferative glomerulonephritis}} | |||
{{CMG}} {{APM}} {{AE}} {{OO}} {{JSS}} {{SAH}} | |||
== Overview == | |||
The optimal therapy for membranoproliferative glomerulonephritis depends on underlying etiology. 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 == | |||
* Pharmacologic therapy is recommended for patients of membranoproliferative glomerulonephritis. Treatment options depends upon underlying etiology.<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> | |||
* Patients with autoimmune etiology are treated with [[immunosuppressive]] therapy. | |||
* Patients with infectious etiology are treated with antivirals or [[Antibiotic|antibiotics]] . | |||
* [[Hepatitis B]] and [[Hepatitis C]] are treated with antivirals. | |||
** [[Leukemia|Leukemias]] and [[Lymphoma|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) [[Angiotensin|Losartan]] PO for 50 mg q daily (100mg per day) | |||
:** '''2.2 Anticoalgulation tharapy''' | |||
:*** [[Heparin|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''' | |||
:**** Preferred regimen (1): [[Atorvastatin clinical studies|Atorvastatin]] PO 10mg q daily | |||
==References== | ==References== | ||
{{reflist|2}} | {{reflist|2}} | ||
{{WH}} | {{WH}} | ||
{{WS}} | {{WS}} | ||
[[Category:Disease]] | [[Category:Disease]] | ||
[[Category:Nephrology]] | [[Category:Nephrology]] | ||
[[Category:Needs content]] | [[Category:Needs content]] | ||
Latest revision as of 20:52, 2 August 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] Syed Ahsan Hussain, M.D.[5]
Overview
The optimal therapy for membranoproliferative glomerulonephritis depends on underlying etiology. 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. Treatment options depends upon underlying etiology.[1][2][3][4]
- Patients with autoimmune etiology are treated with immunosuppressive therapy.
- Patients with infectious etiology are treated with antivirals or antibiotics .
- 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
- Preferred regimen (1): Atorvastatin PO 10mg q daily
- 2.3.1 Life-style modification
- 2.1 Antihypertensive therapy
- 1.1 Immunosuppressive therapy:
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.