2. acute glomerulonephritis
Mode: bed rest to eliminate edema and
hypertension. In the absence of edema and
hypertension, bed rest up to 2 weeks is
recommended
3. acute glomerulonephritis
• Diet
restriction of salt, water, restriction of protein,
with NS - mode of hunger and thirst. When
edema - fasting days: watermelon, vegetable,
sugar, fruit.
4. acute glomerulonephritis
• Etiological treatment - in the presence of
streptococcal focus of infection or detection of
high titers of anti-streptococcal antibiotics -
antibiotics:
• Penicillin was the first antibiotic to be used
clinically in 1941
• Penicillin was originally obtained from the fungus
Penicillium notatum, but the present source is a
high yielding mutant of P. chrysogenum
6. acute glomerulonephritis
• Semisynthetic penicillins are produced by
chemically combining specific side chains or
by incorporating specific precursors in the
mould cultures.
• Aminopenicillins
• This group includes ampicillin, its prodrug
bacampicillin, and amoxicillin
7. acute glomerulonephritis
• Amoxicillin It is a close congener of ampicillin
(but not a prodrug); similar to it in all respects
except
• AMOXYLIN 500 4 times i/m a day
8. acute glomerulonephritis
• MACROLIDE ANTIBIOTICS
These are antibiotics having a macrocyclic
lactone ring with attached sugars. Erythromycin
is the first member discovered in the 1950s,
Roxithromycin, Clarithromycin, Telithromycin
and Azithromycin are the later additions.
9. acute glomerulonephritis
erythromycin 0.25 x 6 times per day per os
Roxithromycin It is a semisynthetic longeracting
acid-stable macrolide whose antimicrobial spectrum
resembles closely with that of erythromycin
Roxithromycin 150 mg x 2 times per day
12. acute glomerulonephritis
Pathogenetic treatment
Hydrocortisone (cortisol) It acts rapidly but has
short duration of action. In addition to primary
glucocorticoid, it has significant mineralocorticoid
activity as well.
Used for: Replacement therapy—20 mg morning +
10 mg afternoon orally. Shock, status asthmaticus,
acute adrenal insufficiency—100 mg i.v. bolus +
100 mg 8 hourly i.v. infusion
13. acute glomerulonephritis
Pathogenetic treatment
Prednisolone It is 4 times more potent than
hydrocortisone, also more selective glucocorticoid,
but fluid retention does occur with high doses. It has
intermediate duration of action: causes less pituitary-
adrenal suppression when a single morning dose or
alternate day treatment is given.
Used for allergic, inflammatory, autoimmune diseases
and in malignancies: 5–60 mg/day oral, 10–40 mg
i.m., intraarticular; also topically.
14. acute glomerulonephritis
Pathogenetic treatment
Methylprednisolone Slightly more potent and more
selective than prednisolone: 4–32 mg/day oral.
Methylprednisolone acetate has been used as a
retention enema in ulcerative colitis.
Pulse therapy with high dose methylprednisolone
(1 g infused i.v. every 6–8 weeks) has been tried in
nonresponsive active rheumatoid arthritis, renal
transplant, pemphigus, etc.
with good results and minimal suppression of
pituitary-adrenal axis.
15. acute glomerulonephritis
Pathogenetic treatment
• Prednisolone - 1 mg/kg/day for 1-1.5 months daily in
two doses in the morning and at lunch, subsequently,
the dose is reduced by 2.5 mg every 5-7 days.
• An alternating regimen is also possible, when the
patient takes a double daily dose every other day. With
an extremely high degree of activity, pulse therapy is
carried out with
• methylprednisolone 1000 mg for 3 days in / in the drip,
then maintenance doses of prednisolone per os
16. acute glomerulonephritis
Pathogenetic treatment
Cytostatics: shown in steroid-resistant and steroid-dependent NS, AH, diabetes
mellitus (DM), gastric and duodenal ulcer:
• azathioprine - 2-3 mg/kg/day;
• cyclophosphamide - 1.5-2 mg/kg/day;
• Leukaran - 0.2 mg/kg/day;
• cyclosporine A (selective immunosuppressant) - an initial dose of 3-5
mg/kg/day.
Duration 4-8-10 weeks, supporting dose 1 / 2-1 / 3 of the optimal dose for 4-6
months:
Complications of treatment with cytostatics:
- leukemia, therefore, control of the complete blood count every 3 days is
necessary;
- bone marrow suppression;
- development of infections;
- gonad deficiency
17. acute glomerulonephritis
Symptomatic therapy
• Treatment with anticoagulants and
antiplatelet agents:
• Heparin in 5000 IU i/v in 6 hours - up to 5-7
days. Indications for heparin therapy:
nephrotic form of AGN, the development of
acute renal failure and the development of
disseminated intravascular coagulation
syndrome in AGN
18. acute glomerulonephritis
Symptomatic therapy
• Treatment with anticoagulants and
antiplatelet agents:
• fenilin 0.03 x 3 times a day or varfarin 2.5-7.5
mg/day, under the control of the prothrombin
index (PTI) and the international normalized
ratio
20. chronic glomerulonephritis
• Pathogenetic treatment
GCS: have anti-inflammatory desensitizing and
immunosuppressive properties. Under their
influence, diuresis increases, swelling and
urinary syndrome disappear: proteinuria,
cylindruria; the protein composition of the
blood improves, hypercholesterolemia
decreases.
21. chronic glomerulonephritis
Pathogenetic treatment
• Indications for corticosteroids:
• • clinical indications for the prescription of
GCS: nephrotic variant, exacerbation of the
variant with isolated urinary syndrome with
the threat of its transition to nephrotic, mixed
version with moderate hypertension, acute
nephritic syndrome
22. • Treatment regimens for GCS:
• • regular dose of 1-2 mg / kg / day. (once or
fractionally) - at least 6 weeks, then gradual
decrease to a maintenance dose (10-20 mg) -
for 2 months or more
• alternative method: double dose (most often
supporting) every other day
23. • pulse therapy: 0.5-1.0 g of
methylprednisolone for 20-40 minutes every
other day (a total of 3-4g). Contraindications:
severe hypertension and cardiomyopathy.
There is a danger of heart failure.
24. • GCS with nephrotic form of GN:
• • Prednisone 1 mg / kg / day. (or 60-80 mg /
day.) - 6 weeks, then a gradual dose reduction
of 2.5 mg every 3 days with the development
of maintenance therapy.
• Contraindications for GCS - hypertensive and
mixed form of GN
25. • Cytostatics: immunosuppressive, anti-
inflammatory and depressing proliferative
processes of action
• Indications for cytostatic therapy: steroid
resistance, steroid dependence, impossibility of
administering GCS or high doses thereof, mixed
variant of GN with high AH, pronounced side
effects or complications of GCS, rapidly
progressing GN, moderate fibroplastic changes in
the biopsy
26. • Alkylating compounds: violate cell division and
protein synthesis:
• • cyclophosphamide - 2-2.5 mg / kg / day.
orally, pulse therapy i / v 15 mg / kg, with GFR
<30 ml / min - 10 mg / kg, a course of
treatment 6 g);
• • chlorbutin - 0.1-0.2 mg / kg / day. inside
27. • Antimetabolites: inhibit enzymes involved in
the synthesis of deoxyribonuclease (DNA):
• • azathioprine -1-3 mg / kg / day. inside.
28. • Selective immunosuppressants:
• • cyclosporin - inhibits the activity of T-helper
cells (CD4 +), production of IL-2, cytotoxic T-
cells
29. • mycophenolate mofetil (cellcept, myfortik) - inhibits
(reversibly) the enzyme for the synthesis of purines
(inosine monophosphate dehydrogenase), interferes
with replication of T and B lymphocytes, inhibits the
formation of antibodies; reduces the proliferation of
macrophages and mesangial cells, reduces the
production of mesangial and tubulointerstitial matrix.
It has a high selectivity of action and less toxicity.
Cellcept is prescribed in a daily dose of 1-2 g / day.
With the appearance of gastrointestinal disorders, a
transfer to a mayfortic is desired - 720 mg are
equivalent to 1 g of Cellcept.
30. • Aminokhinolinic drugs: when CGN with
isolated urinary syndrome - Plaquenil 1 tab.
per day for 8-12 months
31. • Anticoagulants: efficiency is associated with the
effect on the immune component of the
pathogenesis of nephritis due to its
anticomplementary properties, as well as with the
suppression of the activity of hyaluronidase and a
decrease in the permeability of BMC; reduces
platelet aggregation in the glomeruli, improves
microcirculation in them and retards the
progression of morphological damage. Shown in
NA:
• • Heparin 20-40 thousand. Units s / c - 3-10 weeks.
32. • . Combination therapy
• pulse therapy with ultra-high doses of prednisone 1000 mg IV
drip daily - 3 days;
• antimetabolites (azathioprine) and alkylating agents
(cyclophosphamide) 2-3 mg / kg / day. - 4-8-10 weeks, then the
maintenance dose of 50 mg - 6-12 months.
4-part combination therapy: with NS, rapidly progressive GN:
• cyclophosphamide 2 mg / kg / day;
• Prednisone 0.5 mg / kg / day. (or 30 mg / day);
• Heparin 10-20 thousand. Units s / c - 1 month, then fenilin
under the control of PTI;
• chimes 400-600 mg / day. - 6-8 weeks, then 75 mg - 6-12
months
