Journal Article

The treatment of glomerular disease—a compromise between the standard and the individual approach

Boriana Kiperova

in Nephrology Dialysis Transplantation

Published on behalf of European Renal Association - European Dialysis and Transplant Assoc

Volume 18, issue suppl_5, pages v31-v33
Published in print July 2003 | ISSN: 0931-0509
Published online July 2003 | e-ISSN: 1460-2385 | DOI: http://dx.doi.org/10.1093/ndt/gfg1041
The treatment of glomerular disease—a compromise between the standard and the individual approach

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Chronic glomerulonephritis (GN) is one of the leading causes of end-stage renal disease (ESRD). The possibilities for successful treatment in the earliest stages are still limited. Immunosuppressive treatment leads to complete or partial remission only in some patients. Even then, a non-immunological evolution to chronic renal insufficiency often enters a progressive course. By applying a consistent strategy for their individual evaluation and management, it is possible to improve the outcome of patients with GN. The early referral to a nephrologist and an early histomorphological diagnosis; the precise assessment of the type of injury, i.e. proliferative or non-proliferative; the indices of activity and chronicity; and the prognostic indicators are helpful for the therapeutic approach. The goal of the management of GN has to be to suppress the disease with minimum side effects of the treatment. Many unanswered questions and controversies remain concerning the immunosuppressive therapy. A precise distinction is needed between the problematic assertions and evidence-based protocols. A common task for the treatment of all types of chronic GN should be the protection of renal structure and function: control of blood pressure, action on renal haemodynamics and proteinuria via pharmacological inhibition of the renin–angiotensin system, control of hyperlipidaemia and limitation of fibrosis. Some novel and promising pharmacological approaches to extracellular matrix accumulation and chronic interstitial fibrosis are in progress.

Keywords: actions on non-immunological progression; diagnostic approach; immunosuppressive treatment; primary chronic glomerulonephritis

Journal Article.  1678 words. 

Subjects: Nephrology

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