What is High-Efficiency and what is High-Flux ?

Unusually Low or High Endogenous Creatinine

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