Chronic Glomeruloneph kidney disease nephron

Kidney disease

1. Chronic glomerulonephritis Dr : Dolgalev D.V.

2. Causes Glomerulonephritis can be primary, originating in the kidneys, or secondary, caused by a vast array of disorders. Those disorders may affect other parts of the body.

3. SOME CAUSES OF GLOMERULONEPHRITIS Infections Bacterial infections (for example, with streptococcus, staphylococcus, or pneumococcus ) Fungal infections Parasitic infections (for example, malaria) Viral infections (for example, hepatitis B and C or HIV infections)

4. SOME CAUSES OF GLOMERULONEPHRITIS Vasculitis   (blood vessel inflammation) Cryoglobulinemia Eosinophilic granulomatosis with polyangiitis (formerly, Churg -Strauss syndrome) Granulomatosis with polyangiitis (formerly, Wegener granulomatosis ) Microscopic polyangiitis Immune disorders Goodpasture syndrome Systemic lupus erythematosus (lupus) Other causes Hereditary nephritis Drugs (for example,  quinine ,  gemcitabine , or  mitomycin  C)

5. Minimal-Change Disease (MCD) in Adults Treatment of Initial Episode of Adult MCD The Work Group recommends that corticosteroids be given for initial treatment of nephrotic syndrome. The Work Group suggests prednisone or prednisolone * be given at a daily single dose of 1 mg/kg (maximum 80 mg) or alternate-day single dose of 2 mg/kg (maximum 120 mg). The Work Group suggests the initial high dose of corticosteroids, if tolerated, be maintained for a minimum period of 4 weeks if complete remission is achieved, and for a maximum period of 16 weeks if complete remission is not achieved.

6. Minimal-Change Disease (MCD) in Adults Treatment of Initial Episode of Adult MCD In patients who remit, the Work Group suggests that corticosteroids be tapered slowly over a total period of up to 6 months after achieving remission. For patients with relative contraindications or intolerance to high-dose corticosteroids - oral cyclophosphamide or CNIs as discussed in frequently relapsing MCD

7. Supportive Therapy The Work Group suggests that MCD patients who have acute kidney injury (AKI) be treated with renal replacement therapy as indicated, but together with corticosteroids, as for a first episode of MCD. The Work Group suggests that, for the initial episode of nephrotic syndrome associated with MCD, statins not be used to treat hyperlipidemia , and ACE-I or ARBs not be used in normotensive patients to lower proteinuria . ( 2D )

8. Idiopathic Focal Segmental Glomerulosclerosis in Adults Initial Treatment of FSGS The Work Group recommends that corticosteroid and immunosuppressive therapy be considered only in idiopathic FSGS associated with clinical features of the nephrotic syndrome. ( 1C ) The Work Group suggests prednisone* be given at a daily single dose of 1 mg/kg (maximum 80 mg) or alternate-day dose of 2 mg/kg (maximum 120 mg). ( 2C ) The Work Group suggests the initial high dose of corticosteroids be given for a minimum of 4 weeks; continue high-dose corticosteroids up to a maximum of 16 weeks, as tolerated, or until complete remission has been achieved, whichever is earlier. ( 2D )

9. Idiopathic Focal Segmental Glomerulosclerosis in Adults Initial Treatment of FSGS The Work Group suggests corticosteroids be tapered slowly over a period of 6 months after achieving complete remission. ( 2D ) The Work Group suggests CNIs be considered as first-line therapy for patients with relative contraindications or intolerance to high-dose corticosteroids (e.g., uncontrolled diabetes, psychiatric conditions, severe osteoporosis). ( 2D )

10. Idiopathic Membranous Nephropathy (IMN) The Work Group recommends that initial therapy consist of a 6-month course of alternating monthly cycles of oral and intravenous ( i.v .) corticosteroids, and oral alkylating agents ( 1B ) The Work Group suggests using cyclophosphamide rather than chlorambucil for initial therapy. ( 2B )

11. Idiopathic Membranous Nephropathy (IMN) The Work Group recommends patients be managed conservatively for at least 6 months following the completion of this regimen before being considered a treatment failure if there is no remission, unless kidney function is deteriorating or severe, disabling, or potentially life-threatening symptoms related to the nephrotic syndrome are present ( 1C )

12. Idiopathic Membranous Nephropathy (IMN) Perform a repeat kidney biopsy only if the patient has rapidly deteriorating kidney function (doubling of SCr over 1–2 month of observation), in the absence of massive proteinuria (>15 g/d)

13. Infection-Related Glomerulonephritis (GN) For the following infection-related GN, the Work Group suggests appropriate treatment of the infectious disease and standard approaches to management of the kidney manifestations: ( 2D ) Poststreptococcal GN Infective endocarditis-related GN