From the Guidelines
The initial treatment approach for patients diagnosed with glomerulonephritis should prioritize supportive care and specific therapies based on the underlying cause and disease severity, with a focus on preventing disease progression and reducing proteinuria, as recommended by the most recent guideline 1.
Key Considerations
- Blood pressure control is essential, usually with angiotensin-converting enzyme (ACE) inhibitors or angiotensin II receptor blockers (ARBs) 1.
- Diuretics like furosemide may be added to manage fluid overload and edema.
- For inflammatory forms of glomerulonephritis, immunosuppressive therapy might include corticosteroids, cyclophosphamide, or rituximab.
- Dietary modifications, including sodium restriction and protein moderation, are important.
- Regular monitoring of kidney function, proteinuria, and electrolytes is crucial, with assessments every 1-4 weeks initially.
Treatment Approach
The treatment approach should be individualized based on the severity of presenting symptoms and type of glomerulonephritis, with consideration of the level of GFR for determining safe dosage 1.
- Initial therapy should be started only in patients with nephrotic syndrome and when at least one of the following conditions is met:
- Urinary protein excretion persistently exceeds 4 g/day and remains at over 50% of the baseline value, and does not show progressive decline during antihypertensive and antiproteinuric therapy during an observation period of at least 6 months 1.
- The presence of severe, disabling, or life-threatening symptoms related to the nephrotic syndrome.
- SCr level has risen by 30% or more within 6 to 12 months from the time of diagnosis but the estimated glomerular filtration rate (eGFR) is not less than 25–30 ml/min per 1.73 m2 and this change is not explained by superimposed complications.
Preventing Disease Progression
Prolonged immunosuppression or multiple rounds of immunosuppression may be required to prevent or delay chronic kidney disease progression or the development of kidney failure, with proteinuria reduction as a surrogate endpoint in the treatment of glomerulonephritis 1.
From the Research
Initial Treatment Approach for Glomerulonephritis
The initial treatment approach for patients diagnosed with glomerulonephritis depends on the underlying cause and severity of the disease.
- For patients with asymptomatic haematuria and proteinuria, treatment may involve angiotensin-converting enzyme inhibitors (ACEIs) or angiotensin II receptor antagonists (ARAs) to reduce proteinuria and slow disease progression 2.
- In cases of idiopathic membranous glomerulonephritis, treatment options may include rituximab, which has been shown to be effective in reducing proteinuria and inducing remission 3.
- Alternative therapies, such as the herb Astragalus membranaceus, have also been explored for the treatment of idiopathic membranous nephropathy, with some studies suggesting potential benefits 4.
- For patients with minimal change nephrotic syndrome, rituximab monotherapy has been reported to induce remission in some cases 5.
- In rapidly progressive glomerulonephritis, low-dosage heparin infusion, in combination with prednisone and oral anticoagulant and antithrombotic agents, may help arrest and partially reverse renal failure 6.
Key Considerations
- The gold standard for diagnosis of glomerulonephritis is a kidney biopsy, which can help guide treatment decisions 2.
- A causal approach to classification, rather than a pattern-based approach, is now favored for glomerulonephritis, taking into account the underlying causes and pathogenetic mechanisms of the disease 2.