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Tuesday, 3 December 2013

Nephritis: Glomerulonephritis Treatment In conventional medicine perspective

Nephritis is defined as a condition of inflammation of the nephrons in the kidneys.
Glomerulonephritis is defined as the condition of inflammation of the tiny filters in  kidneys (glomeruli), which filter blood by removing excess fluid, electrolytes and waste and pass them through urination.  

Treatment 
F.1. In conventional medicine perspective
Treatment depends on the underlined causes, symptom and types of glomerulonephritis (Acute or chronic)
F.1.1. If the causes of the disease is the result of hypertension
Blood pressure is the force of blood pushing against the walls of the arteries as the heart pumps out blood. High blood pressure means raising pressure in your heart and staying high over time, damaging the body in many ways.
1. Diuretics
Thiazide diuretics were the first tolerated efficient antihypertensive drugs that significantly reduced cardiovascular morbidity and mortality in placebo-controlled clinical studies. Although these drugs today still are considered a fundamental therapeutic tool for the treatment of hypertensive patients. Thiazide diuretics must be used at appropriate and/or optimal doses to achieve the optimal antihypertensive effect with the smallest occurrence of side effects, including alterations in glucose and lipid profiles and hypokalemia. Moreover, because thiazide diuretics can increase the incidence of new-onset diabetes, especially when combined with beta blockers, caution is advised in using these drugs above all in patients who are at high risk for developing diabetes(29), according to the study by Department of Internal Medicine, University of Pisa(29).

2. Angiotensin-converting enzyme (ACE) inhibitors and Angiotensin II receptor agonists
In the study of a total of 25,035 hypertensive patients newly prescribed an ACE inhibitor or angiotensin II receptor blockers (ARBs), no differences were found in risk of death, coronary disease, chronic kidney disease, or stroke between those prescribed ACE inhibitors and those prescribed ARBs. Patients prescribed ARBs had a greater rate of new-onset diabetes (hazard ratio [HR], 1.28; confidence interval [CI], 1.08-1.52), and this was especially true for women (HR, 1.93; CI, 1.22-3.07). Within a large medical-practice based population, there was no evidence of differential effectiveness between ACE inhibitors and ARBs for most outcomes, with diabetes being the notable exception(30).

3. Etc.

A.2. If the causes of the disease is the result of infection due to invasion of bacteria
Corticosteroid therapy with antibiotics 

There is a report of a 24-years old man who presented to the hospital with fever, fatigue, and rapidly progressive glomerulonephritis. Although renal function in the case worsened despite therapy with antibiotics, a short-term and low dose of corticosteroid therapy with antibiotics was able to recover renal function and the patient finally underwent tricuspid valve-plasty and VSD closure, according to the study by Shiga University of Medical Science, Seta(31). 

A.3. Lupus or vasculitis
Lupus is a chronic, autoimmune disease as as a result of the development of autoantibodies that attack the systems and organs in the body.researchers at the indicated that saturated fatty acid palmitate, but not unsaturated oleate, induces the activation of the NLRP3-ASC inflammasome, causing caspase-1, IL-1β and IL-18 production. Immune-suppressing drugs can be prescribed to control inflammation. 
Immune-suppressing drugs
Tacrolimus, an immune-suppressing drug, at low dosage and serum level to be potentially effective and safe for treatment in patients with LN resistant to sufficient CYC therapy. A tacrolimus dosage of 2-3 mg daily appears to be effective and safe, according to the study by Peking Union Medical College Hospital, Chinese Academy of Medical Sciences(32)

A.4. IgA nephropathy
Treatment strategies have included management of blood pressure and lipids, improvement or stabilization of kidney function, and reduction of proteinuria. Supportive therapies, including angiotensin blockade, should be considered as first-line therapy for patients with urine protein >0.5 g/day and/or blood pressure >140/90 mm Hg. Corticosteroids could be considered as add-on or monotherapy for patients with urine protein >1 g/day with preserved renal function, but conclusive data are lacking for general treatment recommendations for the use of other therapies for IgAN(33).

A.5. Etc.
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Sources
(29) http://www.ncbi.nlm.nih.gov/pubmed/16565243
(30) http://www.ncbi.nlm.nih.gov/pubmed/22747612
(31) http://www.ncbi.nlm.nih.gov/pubmed/15610562
(32) http://www.ncbi.nlm.nih.gov/pubmed/22935463
(33) http://www.ncbi.nlm.nih.gov/pubmed/21954446