Glomerulonephritis treatment

Nassberger, L. et al., Antibodies to neutrophil granulocyte myeloperoxidase and elastase Autoimmune responses in glomerulonephritis due to hydralazine treatment, J. Intern. Med., 229, 261, 1991. 

Ntoso, K.A., Tomaszewski, J.E., Jimenez, S.A. and Neilson, E.G. (1986). Penicillamine-induced rapidly progressive glomerulonephritis in patients with progressive systemic sclerosis successful treatment of two patients and a review of the literature. Amer. J. Kidney Dis. 8 159-163. 

Lupus erythematosus Hydralazine may produce a clinical picture simulating systemic lupus erythematosus including glomerulonephritis. Symptoms usually regress when the drug is discontinued, but residual effects have been detected years later. Long-term treatment with steroids may be necessary. 

Mesangiocapillary glomerulonephritis can occur as a complication of many diseases, such as SEE or as a primary disease. Treatment of the primary disease with steroids, immunosuppres-sives and antiplatelet agents have been attempted with unimpressive results. 

Post-streptococcal glomerulonephritis is the result of infection with the nephritogenic strain of group A hemolytic streptococci. The streptococci are usually isolated from patients with a sore throat and, in developing countries, skin infection like impetigo or infected scabies is an important cause. There is no specific treatment except for antihypertensives, salt restriction and diuretics. Corticosteroids are of no value. The disease is self-limiting but, in some adults, it may progress to 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. 

A 14-year-old boy received an intravenous dose of methylprednisolone 30 mg/kg for progressive glomerulonephritis. After 5 hours, his heart rate had fallen to 50/minute and an electrocardiogram showed sinus bradycardia. His heart rate then fell to 40/minutes and a temporary transvenous pacemaker was inserted and methylprednisolone was withdrawn. His heart rate increased to 80/minutes over 3 days. After a further 3 days, he was treated with oral methylprednisolone 60 mg/m2/day and his heart rate fell to 40/minutes in 5 days. Oral methylprednisolone was stopped on day 8 of treatment and his heart rate normalized. 

Fujieda M, Hattori M, Kurayama H, Koitabashi Y. Members and Coworkers of the Japanese Society for Pediatric Nephrology. Clinical features and outcomes in children with antineutrophil cytoplasmic autoantibodypositive glomerulonephritis associated with propylthiouracil treatment. J Am Soc Nephrol 2002 13(2) 437 I5. 

All of these therapies are under development. The treatment of SLE is still a challenging task for the physician. The importance of the effective treatment of lupus nephritis is reflected by the results of mass urinary screening for school children in Taiwan The most important secondary glomerulonephritis discovered by the screening is SLE with lupus nephritis (L19). In order to achieve a better prognosis, physicians need to be familiar with the effects of autoantibodies, diagnose SLE early, and treat it with appropriate methods. 

Glomerulonephritis has been discussed as a possible consequence of etanercept treatment in two patients, with biopsy-proven mesangial deposits of IgA in one (15). 

A review of 15 other available reports of renal insufficiency and proteinuria in patients with chronic myeloid leukemia or other malignancies confirmed that the histological spectrum of renal lesions associated with interferon alfa is varied, and includes membranous glomerulonephritis, minimal change glomerulonephritis, acute interstitial nephritis, hemolytic-uremic sjmdrome, and thrombotic microangiopathy. Renal comphcations were reversible in nine patients three patients had persistent proteinuria, and four had persistent renal dysfunction, of whom three required chronic hemodialysis. Two-thirds of the patients developed renal comphcations within 1 month of treatment with interferon alfa, and one-third had received a relatively low dosage of interferon alfa (9-15 MU/week). 

In an extensive review of the treatment of minimal lesion glomerulonephritis the use of levamisole was briefly mentioned (6). The author concluded that levamisole has a beneficial effect in this disorder, although no new studies have appeared in recent years and well-controlled studies are scarce. Levamisole appears to be well tolerated in this condition. The adverse effects were neutropenia, rash, and raised liver transaminases. 

Ogata H, Kubo M, Tamaki K, Hirakata H, Okuda S, Fujishima M. Crescentic glomerulonephritis due to rifampin treatment in a patient with pulmonary atypical myco-bacteriosis. Nephron I998 78(3) 319-22. 

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