Membranous glomerulonephritis medical therapy: Difference between revisions
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Revision as of 20:04, 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:
- Angiotensin inhibitior (ACEi) for 6 months PO.
- loop diuretics PO.
Treatment for hyperlipidemia:
- Statins PO.
Treatment for coagulation:
- Low molecular weight or unfractionated heparin, followed by PO warfarin.
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.