How is chronic glomerulonephritis treated?

Updated: Feb 24, 2020
  • Author: Moro O Salifu, MD, MPH, FACP; Chief Editor: Vecihi Batuman, MD, FASN  more...
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Answer

Patients with chronic kidney disease (CKD) who are admitted to the hospital should receive careful monitoring of weight, intake, output, and renal function so that acute kidney injury (AKI) can be diagnosed and treated early if it occurs,. All potentially nephrotoxic agents must be adjusted for the degree of CKD. Furthermore, agents such as nonsteroidal anti-inflammatory drugs (NSAIDs), aminoglycosides, and intravenous (IV) contrast media must be avoided unless the benefits clearly outweigh the risks; they are strongly associated with AKI.

Progression from CKD to end-stage renal disease (ESRD) can be slowed by a variety of measures, including aggressive control of diabetes, hypertension, and proteinuria. Dietary protein restriction, phosphate restriction, and hyperlipidemia control may have significant impact on retarding disease progression. In obese patients, weight reduction and bariatric surgery may have beneficial effects on CKD. [13]

Specific therapies for some glomerular diseases (eg, lupus) should be implemented in appropriate settings. Aggressively manage anemia and renal osteodystrophy (eg, hyperphosphatemia, hypocalcemia, or hyperparathyroidism) before initiating renal replacement therapy. Also, aggressively manage comorbid conditions, such as heart disease and diabetes.

Nephrotic patients (urinary protein excretion >3.5 g/day) may have hyperlipidemia. As a part of cardiovascular health care, the lipid profile should be checked, and lipid-lowering therapy should be started for patients with hyperlipidemia.

Steroid therapy may induce or exacerbate diabetes, hypertension, weight gain, fat redistribution in the trunk (buffalo hump) and face (moon facies), cosmetic problems (eg, hirsutism and acne), and osteoporosis.

Monitor fasting blood glucose levels and blood pressure. Obtain baseline bone densitometry values. Repeat bone densitometry for bone pain. Oral calcium supplements (1 g/day) and vitamin D (400-800 IU/day) are recommended for prophylaxis against osteoporosis.


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