Diagnostic tests and treatment options in glomerular disease: 2014 update.
Glomerular diseases historically have been challenging disorders to comprehend and treat for patients and physicians alike. Kidney biopsy is the gold standard of diagnosis, but the link between pathophysiology and the histologic representation of kidney injury has remained elusive in many of these diseases. As a result, treatment of glomerular disease usually involves therapies that are not specific to disease pathogenesis, such as blockade of the renin-angiotensin-aldosterone system and various immunosuppression regimens. Recent research has resulted in greater insight into some glomerular diseases, leading to the hope that new diagnostic tests and treatments targeting disease-specific mechanisms are on the horizon. We review recent progress on the understanding, diagnosis, and treatment of 4 glomerular diseases: immunoglobulin A nephropathy, focal segmental glomerulosclerosis, the C3 glomerulopathies, and idiopathic membranous nephropathy.
Division of Nephrology, Department of Medicine, Columbia University Medical Center, New York, NY.
Jonathan
J
Hogan
Division of Nephrology, Department of Medicine, Columbia University Medical Center, New York, NY.
Prince
P
Mohan
Division of Nephrology, Department of Medicine, Columbia University Medical Center, New York, NY. Electronic address: nephroman@msn.com.
Gerald B
GB
Appel
D061067:Antibodies, Monoclonal, Humanized / Q000627:therapeutic use; D058846:Antibodies, Monoclonal, Murine-Derived / Q000627:therapeutic use; D003176:Complement C3 / Q000378:metabolism; D005921:Glomerulonephritis / Q000175:diagnosis* / Q000188:drug therapy* / Q000276:immunology / Q000378:metabolism; D005922:Glomerulonephritis, IGA / Q000175:diagnosis / Q000188:drug therapy / Q000276:immunology / Q000503:physiopathology; D015433:Glomerulonephritis, Membranous / Q000175:diagnosis / Q000188:drug therapy; D005923:Glomerulosclerosis, Focal Segmental / Q000175:diagnosis / Q000188:drug therapy; D005938:Glucocorticoids / Q000627:therapeutic use; D006801:Humans; D007155:Immunologic Factors / Q000627:therapeutic use; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D009173:Mycophenolic Acid / Q000031:analogs & derivatives / Q000627:therapeutic use; D016032:Randomized Controlled Trials as Topic; D000069283:Rituximab
D061067:Antibodies, Monoclonal, Humanized; D058846:Antibodies, Monoclonal, Murine-Derived; D003176:Complement C3; D005938:Glucocorticoids; D007155:Immunologic Factors; D007166:Immunosuppressive Agents; D000069283:Rituximab; C481642:eculizumab; D009173:Mycophenolic Acid
C3 glomerulopathies; Immunoglobulin A (IgA) nephropathy; focal segmental glomerulosclerosis; glomerular disease; membranous nephropathy