Complications
Exacerbates the adverse renal effects of ACE inhibitors, angiotensin II receptor antagonists, and non-steroidal anti-inflammatory drugs (NSAIDs), which may lead to acute renal failure. Adjustment of diuretic treatment is required to offload oedema but maintain circulating volume.
Secondary to nephrotic syndrome. Diuretics are the mainstay of treatment.
A higher predisposition that may be related to hypertension and hyperlipidaemia, or any secondary cause of MN that may affect the coronary arteries independently.
Principal determinants of a relatively poor renal outcome include more severe renal dysfunction at presentation, higher level of proteinuria, lack of response to initial treatment, and enhanced amount of fibrotic changes, such as interstitial fibrosis and glomerulosclerosis on initial renal biopsy. Treatment may require renal replacement therapy and ultimately renal transplantation.
Complications of corticosteroids include osteoporosis. Many patients, especially female patients who are taking long-term corticosteroids, are recommended to take calcium and vitamin D supplements.
Likely to be a consequence of increased hepatic lipoprotein synthesis and loss of lipid-regulating proteins in urine. An increase in low-density lipoproteins and cholesterol is the most common pattern. Lowering lipids may not necessarily be renoprotective but does prevent cardiovascular mortality. Initial treatment is with diet and exercise, followed by drug treatment with bile acid sequestrants, fibric acid derivatives, and nicotinic acid.
The most common pattern of hyperlipidaemia is an elevation in cholesterol in combination with low-density lipoproteins. Elevated cholesterol is associated with increased cardiovascular risk, and if diet and exercise alone cannot reduce levels to an acceptable level, then statin therapy is recommended.
Nephrotic syndrome causes urinary loss of antithrombin III, altered levels of proteins C and S, and increased platelet aggregability, resulting in hypercoagulability. Thrombotic complications may result, including renal vein thrombosis, pulmonary embolism, or deep vein thrombosis. Routine screening for renal vein thrombosis is not recommended, but the symptoms and signs to look for include flank pain, haematuria, and a marked elevation in serum lactate dehydrogenase. Anticoagulation with heparin and warfarin is advised if any of these complications develop.
The long-term side effects of cytotoxic agents include reduced fertility, bladder carcinoma, and myelodysplasia, which are the major drawbacks to the universal application of this form of treatment.
Incidence of infection may be increased even in patients not receiving immunosuppressive treatment. This is due to increased urinary loss and catabolism of IgG. Treatment with corticosteroids and immunosuppressants also has an effect.
Prophylaxis for Pneumocystis pneumonia in patients receiving cyclophosphamide and prophylaxis for thrush in patients taking corticosteroids is recommended.
Other infections are treated as they develop.
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