The treatment of a patient with a glomerulonephritis is not only dependent on the specific underlying pathology (i.e. the cause) but also on the renal syndrome encountered. The treatment is a specialised field and usually involves general supportive measures, the treatment of suspected complications as well as specific therapy.
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The principles of the therapy can be summarised as follows:
General and supportive measures
Dietary measures
The precise suggestions vary with the different renal syndromes, but generally the help of a dietitian is called for. Attention is given to the limitation of salt, potassium and protein intake (dietary advice usually takes the patient’s weight and protein loss in the urine into account). Supplemental water-soluble vitamins (vitamins C and B-complex) are usually prescribed.
Treatment of blood pressure
In most patients aggressive (but not precipitous) lowering of blood pressure is indicated.
Reduction of proteinuria
A group of drugs called ACE-inhibitors have been shown to lower the amount of protein in the urine and to decrease the rate of deterioration of renal function. Unless contra-indicated, an ACE-inhibitor should be prescribed to most patients. Other measures include the treatment of hypertension and the reductions of dietary protein.
Treatment of oedema
Diuretics (“water pills”, such as Lasix®) are usually prescribed, but care should be taken not to overdo this modality, as it can be harmful.
The management of complications
Pulmonary oedema
Pulmonary oedema (presenting as severe shortness of breath) can occur both in the nephritic syndrome and in patients with rapidly progressive renal failure. This means there is fluid accumulating on the lungs. Aggressive diuretic therapy, oxygen and other measures are required.
High cholesterol
If significantly elevated, dietary measures and drugs should be employed to lower blood cholesterol.
Thrombosis
In patients who previously suffered a thrombotic incident (‘blood clot’), special measures like warfarin therapy are usually required. Warfarin is a drug which helps to prevent blood clots.
Infections
Prophylactic antibiotics are not used. Constant surveillance and treatment for any indication are however important.
Specific treatment
The specific treatment of the many subtypes of glomerulonephritis is generally under specialist supervision and requires an accurate diagnosis and vigilant follow-up. Therapeutic options include steroid therapy, sometimes combined with other immunosuppressive drugs, such as cyclophosphamide or azathioprine. These measures can be life saving, but can be extremely hazardous when used inappropriately.
Patients with renal failure may require dialysis therapy, either by circulating the patient’s blood through a dialysis machine, which is called heamodialysis, or by infusing fluid into the patients abdominal cavity (peritoneum) and removing this fluid at a later stage, a process called peritoneal dialysis.
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