GLOMERULONEPHRITIS-NEPHROTIC SYNDROME MANAGEMENT

SUMMARY

1. Control of glomerular pressure is vital in any glomerular disease; increased intraglomerular pressure hastens disease progression. ACEis or ARBs are best in decreasing intraglomerular pressure. They have been typically prescribed along with a low-protein diet.

2. Diuretics usually are needed because edema can be severe, but salt restriction and diuretics can precipitate prerenal failure.

3. Note that glucocorticoids +/- cytotoxics are used in most nephrotic syndromes-except those caused by amyloid and diabetes.

4. Anticoagulation is used if there is a significant risk of thrombosis, particularly in severe hypoalbuminemia in membranous glomerulopathy (loss of anti-thrombin III).

5. Be aware of the significant increased rate of infections and vaccinate accordingly.

Reference(s)

Wilkinson, I., Furmedge, D. and Sinharay, R. (2017). Oxford handbook of clinical medicine. Oxford: Oxford University Press. Get it on Amazon.
Feather, A., Randall, D. and Waterhouse, M. (2020). Kumar And Clark’s Clinical Medicine. 10th ed. S.L.: Elsevier Health Sciences. Get it on Amazon.
Hannaman, R. A., Bullock, L., Hatchell, C. A., & Yoffe, M. (2016). Internal medicine review core curriculum, 2017-2018. CO Springs, CO: MedStudy.
Therapeutic Guidelines. Melbourne: Therapeutic Guidelines Limited. https://www.tg.org.au [Accessed 2021].