[Drug Treatment of Chronic Glomerulonephritis: Pro]

Overview

Journal Klin Wochenschr

Specialty General Medicine

Date 1985 Sep 16

PMID 3903340

Authors

K Kuhn

J BRODEHL

K M Koch

U Helmchen

Affiliations

Soon will be listed here.

Abstract

This paper sets out the arguments for drug treatment of chronic glomerulonephritides (GN). Although the pathogenesis and mechanism of progression of chronic GN remained to be clarified, on the basis of controlled studies performed to date, there is a strong case to be made for an aggressive treatment approach to this disease spectrum. For instance, in patients with idiopathic membranous glomerulonephritis a six months treatment with chlorambucil (0.2 mg/KG/day) or prednisone (0.6 mg/KG/day) each given once a day over a period of three months has recently been shown to improve the outcome of the renal functional parameters after three years follow up. In another controlled trial a daily dose of 225 mg dipyridamole and 975 mg aspirin given over 12 months in patients with membrano-proliferative GN type I has been reported to normalize the increased platelet consumption rate and to stabilize the glomerular filtration rate. A third trial has demonstrated that the combined use of cyclophosphamide (100 mg/day) and prednisone (30 mg/day) over several months was superior to the use of prednisone alone (40 mg/day) in improving the long-term prognosis of diffuse-proliferative lupus nephritis (type IV, WHO). In some entities, however, as in IgA-nephritis there is still no evidence for a specific treatment improving the course of the chronic glomerular disease. Other therapeutic problems have to be solved: thus, in patients with minimal change nephropathy with a steroid dependent nephrotic syndrome the benefit of cyclophosphamide (given over three months) or of cyclosporin A is still being investigated. Furthermore, there is some evidence that progression of chronic GN, particularly that of glomerular sclerosing, can be prevented by a low protein diet. The role of eicosanoides and their inhibitors in this context has not yet been fully investigated. The different drug trials and new therapeutic concepts indicate a rapid development of chronic GN treatment. Therefore, a failure to treat actively is difficult to understand.

References

Oldrizzi L, Rugiu C, Valvo E, Lupo A, LoSchiavo C, Gammaro L . Progression of renal failure in patients with renal disease of diverse etiology on protein-restricted diet. Kidney Int. 1985; 27(3):553-7. DOI: 10.1038/ki.1985.46. View

Ciabattoni G, Cinotti G, Pierucci A, Simonetti B, Manzi M, Pugliese F . Effects of sulindac and ibuprofen in patients with chronic glomerular disease. Evidence for the dependence of renal function on prostacyclin. N Engl J Med. 1984; 310(5):279-83. DOI: 10.1056/NEJM198402023100502. View

Clarkson A, Woodroffe A . Therapeutic perspectives in mesangial IgA nephropathy. Contrib Nephrol. 1984; 40:187-94. DOI: 10.1159/000409748. View

Hamazaki T, TATENO S, Shishido H . Eicosapentaenoic acid and IgA nephropathy. Lancet. 1984; 1(8384):1017-8. DOI: 10.1016/s0140-6736(84)92355-9. View

. The primary nephrotic syndrome in children. Identification of patients with minimal change nephrotic syndrome from initial response to prednisone. A report of the International Study of Kidney Disease in Children. J Pediatr. 1981; 98(4):561-4. DOI: 10.1016/s0022-3476(81)80760-3. View

Donadio Jr J, Anderson C, Mitchell 3rd J, HOLLEY K, Ilstrup D, Fuster V . Membranoproliferative glomerulonephritis. A prospective clinical trial of platelet-inhibitor therapy. N Engl J Med. 1984; 310(22):1421-6. DOI: 10.1056/NEJM198405313102203. View

Fischer C, Frolich J . Effect of dexamethasone on in vivo prostanoid production in the rabbit. J Clin Invest. 1984; 74(1):120-3. PMC: 425191. DOI: 10.1172/JCI111391. View

Llach F, Arieff A, Massry S . Renal vein thrombosis and nephrotic syndrome. A prospective study of 36 adult patients. Ann Intern Med. 1975; 83(1):8-14. DOI: 10.7326/0003-4819-83-1-8. View

Strom T . Immunosuppressive agents in renal transplantation. Kidney Int. 1984; 26(3):353-65. DOI: 10.1038/ki.1984.181. View

10.

Trompeter R, Evans P, BARRATT T . Gonadal function in boys with steroid-responsive nephrotic syndrome treated with cyclophosphamide for short periods. Lancet. 1981; 1(8231):1177-9. DOI: 10.1016/s0140-6736(81)92348-5. View

11.

Ito H, Hattori S, Matusda I, Amamiya S, HAJIKANO H, Yoshizawa H . Hepatitis B e antigen-mediated membranous glomerulonephritis. Correlation of ultrastructural changes with HBeAg in the serum and glomeruli. Lab Invest. 1981; 44(3):214-20. View

12.

. A controlled study of short-term prednisone treatment in adults with membranous nephropathy. N Engl J Med. 1979; 301(24):1301-6. DOI: 10.1056/NEJM197912133012401. View

13.

Zucchelli P, Zuccala A, Santoro A, Degli Esposti E, Sturani A, Chiarini C . Characteristics of hypertension in primary IgA glomerulonephritis. Contrib Nephrol. 1984; 40:174-81. DOI: 10.1159/000409746. View

14.

Cannon P . Eicosanoids and the blood vessel wall. Circulation. 1984; 70(4):523-8. DOI: 10.1161/01.cir.70.4.523. View

15.

KINCAID-SMITH P . Mesangial IgA nephropathy. Br Med J (Clin Res Ed). 1985; 290(6462):96-7. PMC: 1415439. DOI: 10.1136/bmj.290.6462.96. View

16.

Futrakul P, Poshyachinda M, MITRAKUL C . Focal sclerosing glomerulonephritis: a kinetic evaluation of hemostasis and the effect of anticoagulant therapy: a controlled study. Clin Nephrol. 1978; 10(5):180-6. View

17.

Brenner B, Meyer T, Hostetter T . Dietary protein intake and the progressive nature of kidney disease: the role of hemodynamically mediated glomerular injury in the pathogenesis of progressive glomerular sclerosis in aging, renal ablation, and intrinsic renal disease. N Engl J Med. 1982; 307(11):652-9. DOI: 10.1056/NEJM198209093071104. View

18.

Cats S, Terasaki P, Perdue S, Mickey M . Preferential effectiveness of cyclosporin in patients receiving kidney transplants after glomerulonephritis. Lancet. 1985; 1(8427):490-1. DOI: 10.1016/s0140-6736(85)92090-2. View

19.

Cattran D, Cardella C, Roscoe J, Charron R, Rance P, Ritchie S . Results of a controlled drug trial in membranoproliferative glomerulonephritis. Kidney Int. 1985; 27(2):436-41. DOI: 10.1038/ki.1985.28. View

20.

Donadio Jr J, HOLLEY K, FERGUSON R, Ilstrup D . Treatment of diffuse proliferative lupus nephritis with prednisone and combined prednisone and cyclophosphamide. N Engl J Med. 1978; 299(21):1151-5. DOI: 10.1056/NEJM197811232992102. View