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MINERVA UROLOGICA E NEFROLOGICA

A Journal on Nephrology and Urology


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Minerva Urologica e Nefrologica 2002 March;54(1):19-27

Copyright © 2002 EDIZIONI MINERVA MEDICA

language: English

Management of membranous nephropathy

Cattran D. C.

From the University Health Network Toronto General Division, Toronto Ontario, Canada


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The man­age­ment of mem­bra­nous neph­rop­a­thy ­first ­requires the rec­og­ni­tion of wheth­er the dis­or­der is pri­mary (idiopath­ic) or sec­on­dary. ­Next, a famil­iar­ity ­with its nat­u­ral his­to­ry and knowl­edge of our cur­rent capac­ity to pre­dict ­those ­patients ­with the ­worst out­come is ­reviewed. Treat­ment ­options of ­those at ­risk of pro­gres­sion ­with immu­no­sup­pres­sive ­drugs is ­then dis­cussed ­along ­with the ­required accom­pa­ni­ment of ­risk reduc­tion strat­e­gies includ­ing ideal­iza­tion of the ­blood pres­sure, the use of angio­ten­sin ­enzyme inhib­i­tor ther­a­py and per­haps die­tary pro­tein restric­tion. As ­well treat­ment direct­ed at oth­er com­pli­ca­tions of the dis­ease pro­cess includ­ing the hyper­lip­i­de­mia and hyper­coa­gu­labil­ity are con­sid­ered as ­part of the man­age­ment to ­reduce ­risks. Last­ly, ther­a­pies direct­ed ­towards pre­vent­ing or reduc­ing the com­pli­ca­tions of immu­no­sup­pres­sive ­drugs ­such as tri­meth­o­prim-sul­fam­e­thox­a­zole pro­phy­lax­is ­against pneu­mo­cys­tis cari­ni pneu­mo­nia and biphos­pho­nates to ­reduce ­bone ­mass ­loss ­from cor­ti­cos­ter­oid ther­a­py are dis­cussed.

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