Minimal-change nephropathy treatment

Proximal renal tubnlar proteinuria is a possible complication in patients treated with high doses of mesalazine, and it is clearly important to monitor renal function in these patients (SEDA-22, 394) (75). Two studies in 21 (76) and 95 (77) patients with ulcerative colitis and Crohn s disease have shown that proteinuria of tubular marker proteins is common and is related to disease activity rather than to treatment with mesalazine. Thus, tubular proteins are not useful predictors of an adverse renal response to the drug. Nephrotic syndrome with minimal change nephropathy has been described with sulfasalazine and mesalazine (SEDA-16, 427). 

Savill JS, Chia Y, Pusey CD. Minimal change nephropathy and pemphigus vulgaris associated with penicillamine treatment of rheumatoid arthritis. Clin Nephrol 1988 29(5) 267-70. 

Wolters J, Frederik P, van Rie H, Zeppenfeldt E. Minimal change nephropathy during gold treatment. A case with unusual his-topathological and immunopathological features. Netherland J Med 1987 31 234-240. 

Among all the types of glomerulonephritis, minimal-change nephropathy is most responsive to treatment. Steroids can induce good responses in most patients during initial treatment as well as relapse. 

FIGURE 47-7. Treatment algorithm for minimal-change nephropathy. (Modified from Bargman. )... 

The immunosuppressive effect of cytotoxic agents, with or without the concurrent use of steroids, can result in serious infections, which are the primary cause of death in patients with minimal-change nephropathy. Other toxicities associated with cyclophosphamide include gonadal fibrosis, which results in sterility, hemorrhagic cystitis, alopecia, and a potential to develop malignancy in those on long-term treatment. Patients on chronic steroid therapy often develop growth retardation, osteoporosis, obesity, and cataracts. ... 

The presenting clinical features in nephrotic adults with minimal-change nephropathy can be indistinguishable from that of FSGS, and renal biopsy is therefore critical in the treatment of adults with nephrotic syndrome. FSGS is two to four times more common in black patients than in white patients. They tend to present with proteinuria more frequently in the nephrotic range and are more likely to experience a rapid decline in renal function. 

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