Internal Medicine

0521779407-08 CUNY1086/Karliner 0 521 77940 7 June 13, 2007 7:47

Glomerular Diseases 633

specific therapy

■Minimal Change Disease: Prednisone for 2 months and then

taper. Second line therapies cyclosporine, cyclophosphamide, other

immunosuppressives.

■Focal glomerulosclerosis: Primary-Idiopathic Disease- Only treat

patients with >3 g proteinuria/Day; Prednisone at a high starting

dose and then taper for at least 6 months. Prednisone failures Rx

with cyclosporine for 6 mo; Alternate therapy cyclophosphamide or

other immunosuppression.

■Membranous Nephropathy: Only treat patients at high risk for renal

failure (heavy proteinuria, increased age, male sex, elevated plasma

creatinine). Possible treatments: 1) monthly steroids alternating with

monthly cyclophosphamide or chlorambucil for 6 mo. 2) 6 months

QOD prednisone in tapering dose. 3) cyclosporine

■MPGN: None proven

■IgA Nephropathy: Control of HBP with ACE inhibitor or ARB; Low

protein diet; Even if BP normal use ACE inhibitor or ARB to decrease

progressive disease. In higher risk patients (males, heavy proteinuria,

high creatinine, etc) may try alternate day steroids for 6 mo, fish oils,

other immunosuppressives

■Poststreptococcal glomerulonephritis: Antibiotics to treat acute

infection; No specific therapy; in most cases renal failure and sxs

resolve spontaneously

■Rapidly Progressive GN

■Anti-GBM disease – steroids, cyclophosphamide and plasmaphere-

sis (to remove anti-GBM antibody)

■ANCA+disease – cyclophosphamide and prednisone

■Immune complex RPGN – treat basic disease (SLE: cyclophos-

phamide and steroids, post-strep: no immunosuppressive)

■Asymptomatic urinary findings: No specific therapy

follow-up

■Follow for remission of proteinuria

■Minimal Change Disease: Relapses in many patients – retreat with

steroids for first and second relapse; Frequent relapses or steroid

resistant use cyclosporine or cyclophosphamide.

■Asymptomatic urinary findings: Biopsy if systemic sx or decrease Ccr

or increase proteinuria >1 g/day

complications and prognosis

■In general persistent heavier proteinuria predicts worse outcome.