An update on glomerulopathies : clinical and treatment by Sharma S Prabhakar

By Sharma S Prabhakar

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American Journal of Kidney Diseases, Vol 52, No 4 (October), 2008: pp 699-705 Ehrenreich T, Churg J. Pathology of membranous nephropathy. Pathol Ann 1968;3:145. Ehrenreich T, Churg J. Pathology of membranous nephropathy. Pathol Ann 1968;3:145. Kidney International (2008) 73, 117–125 Floccari VF,Cosentini M. Giacobbe G. Coppolino S,Campo D, Bolignano A. Case-by-Case Protocol of Membranous Nephropathy Treatment with Endovenous Infusion of High Doses of Human Immunoglobulins Gartner HV, Fischbach H, Wehner H, et al.

Lipid lowering is necessary to reduce cardiovascular risk and to possibly delay the progression of renal disease. 1 Non-immunosuppressive drug treatment Symptomatic relief of edema helps the patient feel better. In most patients, loop diuretics are needed to promote diuresis. Patients with massive edema with impaired oral absorption may require intravenous administration of loop diuretics. In patients with refractory conditions, addition of other diuretics (eg, metolazone) and potassium-sparing agents (eg, spironolactone, triamterene) facilitates diuresis and prevents hypokalemia.

16 An Update on Glomerulopathies – Clinical and Treatment Aspects these studies (18 months, compared with 26 weeks in the study of cyclosporine by Cattran et al). The nephrotoxic effects of calcineurin inhibitors are of concern, particularly if long-term treatment is required as a result of relapses. Managing the use of these agents in patients with reduced GFR can be difficult. Due to this issue, Ponticelli and Villa recommend alternative agents in patients with impaired renal function (creatinine clearance <60 ml/min), severe hypertension or severe interstitial fibrosis and tubular atrophy.

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