Treatment

Question 1

What is the treatment for IgA nephropathy?

Answer 1

• Reassess at 6-12 month intervals if the patient is normotensive, minimal proteinuria and normal GFR. Monitor with BP and urinalysis.
• ACEi/ARBs indicated when patient develops HTN +/or proteinuria (0.5g/day)

Question 2

What is the treatment for rapidly progressive glomerulonephritis?

Answer 2

• Anticoagulants - reduce fibrin

- Plasmapheresis + immunosuppressants (corticosteroids + cyclophosphamide)

Question 3

What is the treatment for HSP?

Answer 3

Managed as IgA nephropathy (steroids)

Question 4

How do you manage anti-GBM disease (goodpastures)?

Answer 4

• Plasma exchange
• Corticosteroids
• Cyclsophosphamide

Question 5

What is the management for nephrotic syndrome?

Answer 5

1. Salt and fluid restriction (1-1 1/2L over 24hrs)
2. Diuretics - loop then thiazide (fluid loss no more than 500-700mls a day)
3. Add ACEi/ARB (reduce proteinuria)
4. Role of anticoagulantion - heparin + warfarin
5. Treat underlying cause
6. Statins - Hyperlipidaemia treatment

Question 6

What is the management for ADPKD?

Answer 6

• Monitoring renal function (kidney size)
• Family screening
• High morbidity secondary to CVD
• BP control from childhood is essential
• Nephrectomy occasionally necessary for severe pain and poor function
• No role for surgical/radiological decompression
• Ongoing research - vasopressin antagonists, somatostatin analogues, metformin and transcription inhibitors

Question 7

What is the treatment of membranoproliferative glomerulonephritis?

Answer 7

ACEi/ARB + BP control. Trial of immunosuppression if no underlying cause found and progressive decline in renal function.

Question 8

What are the treatments for nephrotic syndrome types?

Answer 8

• Minimal change: prednisolone 1mg/kg for 4-16 weeks. Frequent relapses > longer term immune suppression (cyclophosphamide, calcineurin inhibitors)
• FSGS: ACEi/ARB + BP control, corticosteroids in primary (idiopathic) disease and calcineurin inhibitors for 2nd line.
• Membranous nephropathy: ACEi/ARB + BP control. Immunosuppression for those high risk of progression (protein >4g, increased creatinine by 30% for at least 6 months of treatment, GFR >30)

Question 9

What is the treatment for vasculitis?

Answer 9

• Large vessels: usually steroids

- Medium/small: immunosuppression (steroids +/- another agent e.g. cyclophosphamide or methotrexate/azathioprine)

Question 10

What is the treatment for GCA?

Answer 10

Prednisolone 60mg/day or IV methylprednisolone if evolving visual loss or hx of amaurosis fugax

Question 11

What is the treatment for PAN?

Answer 11

Control BP and refer. Steroids for mild cases, steroid-sparing for severe. HepB should be treated after steroid initial treatment.

Question 12

What is the new drug for ADPKD patients?

Answer 12

Tolvaptan

• Need regular renal and liver function tests
• Patient needs to drink plenty of fluids
• Annual MRI volume measurement of kidneys is required