Membranous glomerulonephritis medical therapy
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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 drugs like prednisone and cyclophospamide are recomended for the treatment of autoimmune cause of membranous glomerulonephritis. Drug like Angiotensin receptor inhibitior (ACEi) is recomended for managment of hypertension.
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]
- Preferred regimen (1): prednisone 0.5 mg/kg per day with cyclophospamide 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.
Treatment for proteinuria:
Hpertensive managment:
- Preferred regimen (1) Losartan PO for 50 mg q daily (100mg per day)
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.
- ↑ Whelton PK, Carey RM, Aronow WS, Casey DE, Collins KJ, Dennison Himmelfarb C, DePalma SM, Gidding S, Jamerson KA, Jones DW, MacLaughlin EJ, Muntner P, Ovbiagele B, Smith SC, Spencer CC, Stafford RS, Taler SJ, Thomas RJ, Williams KA, Williamson JD, Wright JT (June 2018). "2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines". Hypertension. 71 (6): e13–e115. doi:10.1161/HYP.0000000000000065. PMID 29133356.