Approach to the Patient with Chronic Glomerular Disease

Document Type

Journal Article

Publication Date

1-1-2015

Journal

Chronic Renal Disease

DOI

10.1016/B978-0-12-411602-3.00037-8

Keywords

Chronic Glomerulonephritis; Chronic Kidney Disease; Nephritic Syndrome; Nephrotic Syndrome

Abstract

© 2015 Elsevier Inc. All rights reserved. Glomerular diseases are a leading cause of chronic kidney disease (CKD). However, most treatment protocols for glomerulonephritis center on acute management. There is far less information regarding the treatment of CKD specifically caused by glomerular diseases. Most forms of glomerulopathy can progress to CKD, especially if not treated early when the disease process is most active. Risk factors for progression of glomerular disease to CKD include the presence of proteinuria (especially in the nephrotic range or greater), decreased eGFR at baseline, and histologic evidence of crescentic glomerulonephritis, glomerulosclerosis and tubulointerstitial fibrosis. The conservative treatment of all chronic renal diseases secondary to glomerulopathy includes blood pressure control, especially with RAAS inhibitors, control of edema with diuretics and a low sodium diet, avoidance of nephrotoxins, and moderation of dietary protein intake. Some therapies, such as control of dyslipidemia, may ameliorate the cardiovascular risk so common in CKD patients. Therapies to prevent tubulointerstitial fibrosis are currently being studied. This chapter presents an overview of management considerations for CKD secondary to glomerular diseases.

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