| Remission of proteinuria in primary glomerulonephritis: we know the goal but do we know the price? | |
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MedLine Citation:
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PMID: 18725916 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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Membranous nephropathy, focal segmental glomerulosclerosis and IgA nephropathy are the most commonly recognized types of primary glomerulonephritis that progress to end-stage renal disease. Persistent proteinuria is a major determinant of such progression. Reduction of proteinuria slows progression of renal disease and improves renal survival, but many of the agents used to reduce proteinuria carry a considerable risk of toxicity. The assessment of benefit versus risk of these medications can be further complicated by the temporal disconnect between the onset of benefit and of serious adverse events. In addition, relapses are common in these disorders and there is often a need for retreatment. Such retreatment might lead to repeated and/or prolonged drug exposure and to the oversight or underestimation of the cumulative dose of these agents because of the potentially extended interval between relapses. Consequently, it is very important to constantly review each patient's status and take into account their age, comorbid conditions and cumulative drug exposure when assessing treatment options. The potentially delayed development of adverse events also emphasizes the need for long-term surveillance of patients who receive immunosuppressive treatment for glomerular disease, often well beyond their drug exposure period and even when the treatment has been successful. |
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Authors:
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David Philibert; Daniel Cattran |
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Publication Detail:
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Type: Journal Article; Review Date: 2008-08-26 |
Journal Detail:
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Title: Nature clinical practice. Nephrology Volume: 4 ISSN: 1745-8331 ISO Abbreviation: - Publication Date: 2008 Oct |
Date Detail:
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Created Date: 2008-09-26 Completed Date: 2009-03-05 Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 101261800 Medline TA: Nat Clin Pract Nephrol Country: England |
Other Details:
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Languages: eng Pagination: 550-9 Citation Subset: IM |
Affiliation:
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University Health Network, Toronto General Research Institute, Toronto, ON, Canada. |
Export Citation:
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APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
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Alkylating Agents
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therapeutic use Calcineurin / antagonists & inhibitors Glomerulonephritis / complications*, drug therapy* Glomerulonephritis, IGA / complications, drug therapy Glomerulonephritis, Membranous / complications, drug therapy Glomerulosclerosis, Focal Segmental / complications, drug therapy Humans Immunosuppressive Agents / therapeutic use Mycophenolic Acid / analogs & derivatives, therapeutic use Proteinuria / drug therapy*, etiology* Remission Induction Risk Factors |
| Chemical | |
Reg. No./Substance:
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0/Alkylating Agents; 0/Immunosuppressive Agents; 128794-94-5/mycophenolate mofetil; 24280-93-1/Mycophenolic Acid; EC 3.1.3.16/Calcineurin |
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