What is the role of dialysis and renal transplantation in the treatment of chronic glomerulonephritis?

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

Discuss options for renal replacement therapy (eg, hemodialysis, peritoneal dialysis, and renal transplantation).

Arrange permanent vascular access when the GFR falls below 20-25 mL/min, when the serum creatinine level exceeds 4 mg/dL, or when the rate of increase in the serum creatinine level indicates the need for dialysis within 1 year. Arteriovenous fistulas are preferred to arteriovenous grafts because of their long-term high-patency rates and should be placed whenever possible. Place peritoneal dialysis catheters 2-3 weeks before anticipated dialysis therapy.

Preemptive transplantation before the initiation of dialysis results in better survival than transplantation after the initiation of dialysis. Therefore, preemptive transplantation should be explored from live donors. Patients without live donors can be placed on the deceased donor wait list when the GFR falls below 20 mL/min to accrue time. Patients who opt for no treatment when it is indicated should be informed of imminent renal failure in a shorter time.

Expose patients to educational programs for early rehabilitation from dialysis or transplantation.


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