Treatment of Glomerulonephritis

General Management Principles

The American College of Physicians recommends restricting dietary sodium to <2.0 g/day to reduce edema, control blood pressure, and help manage proteinuria 1, 2
The National Kidney Foundation suggests using diuretics as first-line agents for edema management, adding mechanistically different diuretics if response is insufficient 1
The American Heart Association recommends monitoring for adverse effects of diuretics including hyponatremia, hypokalemia, GFR reduction, and volume depletion 1
The European Renal Association recommends adjusting protein intake based on degree of proteinuria and kidney function, with 0.8-1 g/kg/day for nephrotic-range proteinuria and additional protein to compensate for losses 1

The American College of Cardiology recommends using ACE inhibitors or ARBs at maximally tolerated doses as first-line therapy for patients with both hypertension and proteinuria 1
The American Heart Association suggests targeting systolic blood pressure <120 mmHg in most adult patients using standardized office BP measurement 1
The National High Blood Pressure Education Program recommends targeting 24-hour mean arterial pressure at ≤50th percentile for age, sex, and height by ambulatory blood pressure monitoring in children 1

The American Society of Nephrology recommends considering observation for 6 months before initiating immunosuppressive therapy for membranous nephropathy unless there are severe symptoms or declining kidney function 1
The European Renal Association suggests using a 6-month course of alternating monthly cycles of oral and IV corticosteroids with oral alkylating agents for membranous nephropathy 1
The National Kidney Foundation recommends using high-dose corticosteroids for a minimum of 4 weeks, up to 16 weeks as tolerated, for nephrotic syndrome due to FSGS 1
The American College of Rheumatology recommends initial therapy with corticosteroids combined with either cyclophosphamide or mycophenolate mofetil for lupus nephritis 3

The National Kidney Foundation suggests assessing proteinuria regularly, with reduction in proteinuria as a marker of treatment response 1, 2
The American Society of Nephrology recommends monitoring for a ≥40% decline in eGFR from baseline over 2-3 years as a surrogate outcome measure for kidney failure 1, 2

The Centers for Disease Control and Prevention recommends administering pneumococcal vaccine to patients with glomerular disease and nephrotic syndrome 1
The American Academy of Pediatrics suggests ensuring patients and household contacts receive influenza vaccine 1
The National Kidney Foundation recommends providing herpes zoster vaccination (Shingrix) 1
The Infectious Diseases Society of America suggests considering prophylactic trimethoprim-sulfamethoxazole for patients receiving high-dose prednisone or other immunosuppressive agents 1

The European Renal Association recommends avoiding protein restriction <0.6 g/kg/day due to safety concerns and risk of malnutrition 2
The American Society of Nephrology suggests screening for latent infections prior to initiating immunosuppression 1, 2
The National Kidney Foundation recommends monitoring therapeutic drug levels where clinically indicated 1, 2
The American College of Physicians suggests reviewing vaccination status and updating as required before starting immunosuppression 1, 2