Skip to Main Content

KEY CONCEPTS

KEY CONCEPTS

  • imageGlomerular diseases are a collection of diseases that affect the filters of the kidney and are mediated by different immunologic pathogenic mechanisms, resulting in varied clinical presentation and therapeutic outcomes.

  • imageThe signs and symptoms associated with glomerular diseases are commonly nephritic (reflecting inflammatory injury) or nephrotic (reflecting noninflammatory injury) in nature, and are characterized by hematuria and proteinuria.

  • imageSupportive treatments for edema, hypertension, hyperlipidemia, and intravascular thrombosis are important in reducing the complications associated with glomerular diseases. These are especially important since specific and effective therapy for many types of glomerular diseases is not available. Reduction of proteinuria can often improve long-term kidney and patient outcomes.

  • imageTo maximize therapeutic benefits and minimize drug-induced complications, patients have to be monitored closely to assess their therapeutic responses as well as the development of any treatment-induced toxicity.

  • imageAmong 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.

  • imageBecause of the lack of consistently effective treatment for primary focal segmental glomerular sclerosis, angiotensin-converting enzyme inhibitors or angiotensin receptor blockers are commonly used for patients with mild disease to control symptoms. Steroids and immunosuppressive agents are reserved for the management of patients with severe disease.

  • imageThe optimal treatment for lupus nephritis depends on the underlying lesion and disease activity, as well as the severity and duration of the patient’s condition.

  • imageThe treatment of poststreptococcal glomerulonephritis is mainly supportive and symptomatic. Antibiotic therapy does not prevent subsequent disease development but may reduce the severity.

PATIENT CARE PROCESS

Patient Care Process for Managing Glomerular Disease

image

Collect

  • Patient characteristics (eg, age, sex, ethnicity)

  • History of present illness (eg, edema, gross hematuria, extra-renal symptoms such as hemoptysis and joint pains)

  • Patient medical history (personal and family)

  • Social history (eg, tobacco use, history of drug use) and dietary habits including sodium intake

  • Current medications including OTC NSAID use and blood pressure medications

  • Objective data

    • Blood pressure (BP), heart rate (HR), respiratory rate (RR), height, weight, O2-saturation

    • Labs including serum creatinine (SCr), serum albumin, complete blood count, urinalysis, and random urine protein:creatinine ratio

    • May consider a limited serologic workup (eg, complement component C3 and C4 levels, antinuclear antibody, anti-phospholipase A2 receptor antibody)

    • Renal ultrasound

Assess

  • Blood pressure (goal generally <130/80 mmHg)

  • Volume status for presence of peripheral edema, pulmonary edema

  • Presence of life-threatening, associated complications such as pulmonary hemorrhage and venous thromboembolism

  • Ability to monitor weights and blood pressures at home

  • Ability to tolerate immunosuppressive therapy such as corticosteroids (eg, hyperglycemia, infection risk, history of depression or psychosis)

  • Ability to pay for treatment options

Plan*

  • Drug therapy regimens including blood pressure control with angiotensin-converting enzyme inhibitors (ACEIs), angiotensin receptor blockers (ARBs)

  • Volume control with diuretics

  • Home monitoring of blood pressures and weights

  • Immunosuppressive therapy, when indicated

  • Regular monitoring of relevant labs

  • Patient education

  • Referral to other providers, when applicable (eg, rheumatologists for ...

Pop-up div Successfully Displayed

This div only appears when the trigger link is hovered over. Otherwise it is hidden from view.