NKF K/DOQI recommended target ranges

Serum phosphorus 3.5 mg/dL–5.5 mg/dL
Serum calcium 8.4 mg/dL–9.5 mg/dL
Ca X P product <55 mg2/dL2
Intact PTH 150 pg/mL–300 pg/mL
Serum total CO3 >22 mmol/L

these are the targets for Bone Metabolism

Summary of Treatment Recommendations for IgAN

All summarised ....

IgAN latest

Management of IgA nephropathy


ACE-inhibitors, ARBs and ACEI/ARB combinations - beneficial

Steroids
Pozzi et al (vs placebo) - better renal survival with steroids
Katafuchi et al (vs placebo) - similar renal survival
A recent metaanalysis also support use of steroids : reduce proteinuria, prevent progression to ESRD

Oral CYC
Ballardie et al. better 5-year renal survival

Fish Oil - conflicting results
Donadio et al. Mayo Clinic. NEJM 1994 (fish oil better)
Pettersson et al (no benefit, in fact worse)
Hogg et al (no benefit)

MMF - no evidence in IgAN

Membranous nephropathy

Management of membranous nephropathy

Chlorambucil } both proven effective by Ponticelli et al
cyclophospamide }

Cyclosporin A (Cattran et al.KI 2001)
CSA + low dose steroids vs steroids only (n=51)
CSA + low dose steroids - more CR/PR (21/28 vs 5/23)

MMF (only uncontrolled trials)
Choi et al. reduced proteinuria
Miller et al. reduced proteinuria

Rituximab (also uncontrolled trials)
Ruggenenti et al. reduced proteinuria up to 1 year.

FSGS latest update

Management of FSGS

Steroid-resistant FSGS
Cyclosporin A vs placebo (Cattran et al. KI 1999)
CR/PR : 70% vs 4% (CSA much better)

MMF : Choi et al (n=18) but not controlled. New NIH multicenter RCT ongoing
Sirolimus : no evidence

PD Guidelines : Quick Summary

European Best Practice Guidelines

UF > 1L/day
Kt/V > 1.7 per week

UK Renal Guidelines

CCr 50L/week
Kt/V > 1.7 per week

KDOQI Guidelines

CCr 50-60L/week
Kt/V > 2.0 per week

Strategies to Expand Living Donor Pool

Due to the lack of living donors here, this is something we need to know :

What are the strategies available to expand Living Donor Pool?

1) Use of genetically unrelated donors such as a spouse, friend or acquaintance (emotionally related donors) or a stranger(altruistic or living nondirected donors [LNDs])

2) Paired-donor kidney exchanges, either direct (living-donor–living-donor) exchanges (kidney-paired donation) or indirect (living-donor–deceased-donor) exchanges (list-paired donation)

3) Integration of paired exchanges with LND donation, as either domino-paired donation (LND donation plus direct exchanges) or chain-paired donation (LND donation plus direct and indirect exchanges)

4) Transplantation across ABO or HLA barriers using desensitization techniques

5) Use of expanded-criteria living donors including hypertensive donors, obese donors and elderly donors