Glomerulonephritis nephrotic syndrome

Signs and symptoms of gold toxicity, the primary serious reaction, include decreased Hgb level, decreased granulocyte count (less than 150,000/mm ), proteinuria, hematuria, stomatitis, blood dyscrasias (anemia, leukopenia WBC count less than 4000/mm, thrombocytopenia, and eosinophilia), glomerulonephritis, nephrotic syndrome, and cholestatic jaundice. 

Diseases in which immunosuppression may be useful include tissue transplantation, inflammatory bowel disease, rheumatoid arthritis, chronic active hepatitis, systemic lupus erythematosus, glomerulonephritis, nephrotic syndrome, some haemolytic anaemias and thrombocytopenias, uveitis, myasthenia gravis, polyarteritis, polymyositis, systemic sclerosis, Behcet s syndrome. 

Edema Adjunctive therapy in edema associated with congestive heart failure (CHF), hepatic cirrhosis, and corticosteroid and estrogen therapy. Useful in edema due to renal dysfunction (eg, nephrotic syndrome, acute glomerulonephritis, chronic renal failure). 

Nephrotic syndrome is characterized by proteinuria and edema due to some form of glomerulonephritis. The resulting fall in plasma protein concentration decreases vascular volume, which leads to diminished renal blood flow. This in turn causes secondary aldosteronism characterized by Na and water retention and K+ depletion. Rigid control of dietary Na is essential. Therapy of the nephrotic syndrome using a thiazide (possibly with a K -sparing diuretic) to control the secondary aldosteronism, is a useful initial approach to treatment Since nephrotic edema is frequently more difficult to control than cardiac edema, it may be necessary to switch to a loop diuretic (and spironolactone) to obtain adequate diuresis. 

Unlabeled Uses Treatment of biliary cirrhosis, chronic acfive hepatitis, glomerulonephritis, inflammatory bowel disease, inflammatory myopathy, multiple sclerosis, myasthenia gravis, nephrotic syndrome, pemphigoid, pemphigus, polymyositis, systemic lupus erythematosus... 

The main clinical uses of immunosuppressive drugs are suppression of organ and tissue rejection after transplant surgery and the treatment of diseases with an autoimmune component. Thses include renal diseases, e.g. glomerulonephritis, some nephrotic syndromes, connective tissue diseases, such as systemic lupus erythematosus rheumatoid arthritis, and systemic vasculitis. 

Nephrotic syndrome and immune complex glomerulonephritis have been attributed to chlorpropamide (119). 

Appel GB, D Agati V, Bergman M, Pirani CL. Nephrotic syndrome and immune complex glomerulonephritis associated with chlorpropamide therapy. Am J Med 1983 74(2) 337-42. 

Renal diseases Decreased inflammation Nephrotic syndrome, membranous glomerulonephritis... 

Zanetta G, Maurice-Estepa L, Mousson C, Justrabo E, Daudon M, Rifle G, Tanter Y. Foscarnet-induced crystal-hne glomerulonephritis with nephrotic syndrome and acute renal failure after kidney transplantation. Transplantation 1999 67(10) 1376-8. 

Like many other NSAIDs, ketoprofen can cause acute interstitial nephritis (10). Renal insufficiency and the nephrotic syndrome due to membranous glomerulonephritis (an unusual cause of NSAID-induced nephrotic syndrome) have been described in an elderly patient taking long-term ketoprofen (SEDA-12, 86). 

Bindi P, Gilson B, Aymard B, Noel LH, Wieslander J. Antiglomerular basement membrane glomerulonephritis following D-penicillamine-associated nephrotic syndrome. Nephrol Dial Transplant 1997 12(2) 325-7. 

In usual doses, 600-800 mg/day, pyritinol has a profile of adverse reactions reminiscent of that of penicillamine (2,3). Some 40% of users have adverse reactions, leading to withdrawal in about 23% of the total. The most common are non-specific rashes and stomatitis in addition, pemphigus, lichen planus, and photosensitivity have occurred. Gastrointestinal symptoms (diarrhea, gastral-gia, nausea, loss of taste) can occur, but are less frequent than with penicillamine. Thrombocytopenia, reversible extramembranous glomerulonephritis with nephrotic syndrome (4), a myasthenia-like picture, and acute polymyositis with positive rechallenge have also been described (5). 

Glomerulonephritis has been reported in association with Henoch-Schonlein purpura (46) and nephrotic syndrome, possibly as part of a lupus-like syndrome (47). 

Some degree of renal damage occurs in about 10% of patients taking tiopronin (1-3,5,6). As with penicillamine, proteinuria can progress to nephrotic syndrome (13,14). Biopsy may show minimal change membranous glomerulonephritis and granular depositions of IgG and C3 (13,15). 

Harman JW, Miller EC, Miller JA. Chronic glomerulonephritis and nephrotic syndrome induced in rats by N, N -diacetylbenzidine. Am J Pathol 1952 28 529. 

The kidneys are more sensitive than many other organs to drug toxicity. Immune-mediated, drug-induced nephrotoxicities include glomerulonephritis and allergic interstitial nephritis, either with or without nephrotic syndrome. The kidney is highly susceptible in part because of its large vascular surface area for exposure to circu-... 

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